| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
27,317 |
26,467 |
$1.36M |
| T4535 |
Disposable liner/shield/pad |
16,886 |
16,378 |
$910K |
| T4523 |
Adult size brief/diaper lg |
11,380 |
10,983 |
$908K |
| T4522 |
Adult size brief/diaper med |
9,762 |
9,485 |
$554K |
| T4524 |
Adult size brief/diaper xl |
6,424 |
6,232 |
$533K |
| T4537 |
Reusable underpad bed size |
6,911 |
6,638 |
$129K |
| T4543 |
Adult disp brief/diap abv xl |
856 |
831 |
$121K |
| A4927 |
Non-sterile gloves |
22,112 |
21,465 |
$69K |
| E0260 |
Hosp bed semi-electr w/ matt |
2,681 |
2,667 |
$63K |
| K0001 |
Standard wheelchair |
2,336 |
2,325 |
$44K |
| T4521 |
Adult size brief/diaper sm |
823 |
796 |
$42K |
| A4239 |
Non-adju cgm supply allow |
1,156 |
1,091 |
$41K |
| T4539 |
Reuse diaper/brief any size |
1,241 |
1,177 |
$27K |
| T4540 |
Reusable underpad chair size |
1,934 |
1,852 |
$26K |
| E0630 |
Patient lift hydraulic |
698 |
698 |
$14K |
| V5266 |
Battery for hearing device |
584 |
582 |
$13K |
| A4402 |
Lubricant per ounce |
1,965 |
1,896 |
$7K |
| K0553 |
Ther cgm supply allowance |
125 |
123 |
$6K |
| E0143 |
Walker folding wheeled w/o s |
273 |
273 |
$6K |
| K0739 |
Repair/svc dme non-oxygen eq |
129 |
118 |
$5K |
| K0195 |
Elevating whlchair leg rests |
975 |
970 |
$3K |
| E0156 |
Walker seat attachment |
271 |
271 |
$2K |
| E2611 |
Gen use back cush wdth <22in |
12 |
12 |
$1K |
| A4357 |
Bedside drainage bag |
134 |
113 |
$512.44 |
| E0185 |
Gel pressure mattress pad |
16 |
16 |
$427.48 |
| A4358 |
Urinary leg or abdomen bag |
109 |
104 |
$328.51 |
| E2601 |
Gen w/c cushion wdth < 22 in |
12 |
12 |
$278.89 |
| E0978 |
W/c acc,saf belt pelv strap |
14 |
14 |
$179.32 |
| A4253 |
Blood glucose/reagent strips |
13 |
12 |
$65.86 |
| A4314 |
Cath w/drainage 2-way latex |
12 |
12 |
$57.75 |
| A4338 |
Indwelling catheter latex |
12 |
12 |
$22.16 |
| A4310 |
Insert tray w/o bag/cath |
13 |
13 |
$17.87 |
| A4259 |
Lancets per box |
13 |
12 |
$3.40 |