| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4526 |
Adult size pull-on med |
7,376 |
7,083 |
$720K |
| A4554 |
Disposable underpads |
14,564 |
13,834 |
$703K |
| T4527 |
Adult size pull-on lg |
5,374 |
5,206 |
$659K |
| T4528 |
Adult size pull-on xl |
4,705 |
4,486 |
$606K |
| T4522 |
Adult size brief/diaper med |
3,304 |
3,164 |
$309K |
| T4524 |
Adult size brief/diaper xl |
1,541 |
1,469 |
$207K |
| T4523 |
Adult size brief/diaper lg |
1,581 |
1,519 |
$163K |
| E1390 |
Oxygen concentrator |
1,197 |
1,118 |
$114K |
| A4927 |
Non-sterile gloves |
8,236 |
7,931 |
$97K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,620 |
1,523 |
$53K |
| K0003 |
Lightweight wheelchair |
1,756 |
1,668 |
$51K |
| E0603 |
Electric breast pump |
514 |
512 |
$45K |
| A6214 |
Foam drg > 48 sq in w/border |
379 |
347 |
$38K |
| E0143 |
Walker folding wheeled w/o s |
660 |
619 |
$22K |
| L0642 |
Lo sag ri an/pos pnl pre ots |
140 |
140 |
$21K |
| A4670 |
Automatic bp monitor, dial |
636 |
619 |
$16K |
| K0195 |
Elevating whlchair leg rests |
1,878 |
1,796 |
$15K |
| A6402 |
Sterile gauze <= 16 sq in |
304 |
288 |
$9K |
| E0431 |
Portable gaseous 02 |
363 |
348 |
$9K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
90 |
86 |
$8K |
| E1392 |
Portable oxygen concentrator |
551 |
513 |
$4K |
| E1353 |
Oxygen supplies regulator |
43 |
41 |
$3K |
| A6197 |
Alginate drsg >16 <=48 sq in |
15 |
12 |
$2K |
| E0105 |
Cane adjust/fixed quad/3 pro |
77 |
76 |
$2K |
| E0245 |
Tub stool or bench |
40 |
39 |
$2K |
| B4150 |
Ef complet w/intact nutrient |
13 |
13 |
$2K |
| E0156 |
Walker seat attachment |
212 |
192 |
$2K |
| L8310 |
Truss double w/ standard pad |
16 |
16 |
$1K |
| A4660 |
Sphyg/bp app w cuff and stet |
81 |
80 |
$1K |
| A4452 |
Waterproof tape |
71 |
65 |
$467.80 |
| L0621 |
Sio flex pelvic/sacr pre ots |
16 |
16 |
$407.82 |
| E0163 |
Commode chair with fixed arm |
14 |
13 |
$321.50 |
| E0978 |
W/c acc,saf belt pelv strap |
14 |
14 |
$149.81 |
| E0159 |
Brake for wheeled walker |
13 |
12 |
$4.75 |
| 0004A |
|
22 |
22 |
$0.00 |
| 0124A |
|
20 |
20 |
$0.00 |
| 0003A |
|
15 |
15 |
$0.00 |
| M0201 |
Pne flu hepb cov home admin |
63 |
60 |
$0.00 |