| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
25,881 |
23,390 |
$2.77M |
| T4526 |
Adult size pull-on med |
21,965 |
19,851 |
$2.19M |
| A4927 |
Non-sterile gloves |
67,649 |
60,970 |
$2.18M |
| A4554 |
Disposable underpads |
47,971 |
42,721 |
$1.60M |
| T4528 |
Adult size pull-on xl |
12,934 |
11,872 |
$1.35M |
| T4544 |
Adlt disp und/pull on abv xl |
2,855 |
2,573 |
$390K |
| T4523 |
Adult size brief/diaper lg |
2,643 |
2,433 |
$321K |
| T4524 |
Adult size brief/diaper xl |
2,291 |
2,086 |
$269K |
| T4525 |
Adult size pull-on sm |
1,760 |
1,479 |
$158K |
| T4522 |
Adult size brief/diaper med |
1,303 |
1,216 |
$144K |
| B4035 |
Enteral feed supp pump per d |
4,267 |
2,231 |
$96K |
| B4152 |
Ef calorie dense>/=1.5kcal |
3,475 |
1,790 |
$76K |
| T4543 |
Adult disp brief/diap abv xl |
440 |
367 |
$69K |
| B4154 |
Ef spec metabolic noninherit |
973 |
563 |
$42K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,069 |
1,015 |
$36K |
| K0001 |
Standard wheelchair |
4,121 |
2,505 |
$25K |
| T5999 |
Supply, nos |
3,525 |
3,186 |
$19K |
| E0261 |
Hosp bed semi-electr w/o mat |
1,568 |
1,548 |
$15K |
| A4253 |
Blood glucose/reagent strips |
3,058 |
2,685 |
$11K |
| B4034 |
Enter feed supkit syr by day |
785 |
471 |
$9K |
| B9002 |
Enter nutr inf pump any type |
298 |
182 |
$3K |
| E0184 |
Dry pressure mattress |
24 |
22 |
$844.78 |
| A4256 |
Calibrator solution/chips |
1,847 |
1,216 |
$764.11 |
| A4259 |
Lancets per box |
2,395 |
1,650 |
$675.22 |
| E0776 |
Iv pole |
429 |
310 |
$535.03 |
| K0195 |
Elevating whlchair leg rests |
47 |
26 |
$332.51 |
| E0971 |
Wheelchair anti-tipping devi |
15 |
12 |
$214.03 |
| E0607 |
Blood glucose monitor home |
26 |
15 |
$115.98 |