| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
19,387 |
17,823 |
$645K |
| T4528 |
Adult size pull-on xl |
4,808 |
4,438 |
$327K |
| T5999 |
Supply, nos |
34,345 |
28,355 |
$326K |
| T4527 |
Adult size pull-on lg |
5,982 |
5,193 |
$304K |
| T4526 |
Adult size pull-on med |
5,145 |
4,663 |
$254K |
| T4534 |
Youth size pull-on |
2,290 |
2,227 |
$253K |
| T4543 |
Adult disp brief/diap abv xl |
1,451 |
1,291 |
$183K |
| T4535 |
Disposable liner/shield/pad |
5,783 |
5,412 |
$173K |
| T2028 |
Special supply, nos waiver |
831 |
724 |
$163K |
| X1939 |
|
2,368 |
2,093 |
$140K |
| T4524 |
Adult size brief/diaper xl |
1,348 |
1,210 |
$104K |
| T4525 |
Adult size pull-on sm |
1,875 |
1,553 |
$103K |
| K0001 |
Standard wheelchair |
2,338 |
2,192 |
$80K |
| T4522 |
Adult size brief/diaper med |
1,325 |
1,089 |
$80K |
| A4927 |
Non-sterile gloves |
7,181 |
5,039 |
$77K |
| X1915 |
|
390 |
380 |
$68K |
| E0601 |
Cont airway pressure device |
629 |
566 |
$40K |
| X1922 |
|
200 |
200 |
$35K |
| K0006 |
Heavy duty wheelchair |
633 |
591 |
$32K |
| T4523 |
Adult size brief/diaper lg |
443 |
368 |
$28K |
| L4360 |
Pneumat walking boot pre cst |
84 |
81 |
$16K |
| E0570 |
Nebulizer with compression |
100 |
100 |
$13K |
| E0149 |
Heavy duty wheeled walker |
367 |
345 |
$9K |
| T4532 |
Ped size pull-on lg |
48 |
48 |
$4K |
| T4530 |
Ped size brief/diaper lg |
54 |
50 |
$4K |
| A4357 |
Bedside drainage bag |
253 |
234 |
$4K |
| L3908 |
Who cock-up nonmolde pre ots |
48 |
39 |
$2K |
| A7005 |
Nondisposable nebulizer set |
76 |
76 |
$2K |
| E0143 |
Walker folding wheeled w/o s |
42 |
38 |
$1K |
| A4358 |
Urinary leg or abdomen bag |
101 |
89 |
$1K |
| A7038 |
Pos airway pressure filter |
12 |
12 |
$41.83 |
| A7015 |
Aerosol mask used w nebulize |
17 |
17 |
$27.52 |