| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
17,168 |
16,861 |
$723K |
| T4527 |
Adult size pull-on lg |
3,406 |
3,350 |
$468K |
| T4528 |
Adult size pull-on xl |
1,796 |
1,784 |
$369K |
| T4526 |
Adult size pull-on med |
2,601 |
2,565 |
$313K |
| T4544 |
Adlt disp und/pull on abv xl |
1,035 |
977 |
$263K |
| T4535 |
Disposable liner/shield/pad |
5,207 |
5,091 |
$230K |
| T4532 |
Ped size pull-on lg |
1,470 |
1,419 |
$192K |
| T4530 |
Ped size brief/diaper lg |
1,342 |
1,321 |
$125K |
| A4335 |
Incontinence supply |
18,132 |
17,500 |
$94K |
| A6250 |
Skin seal protect moisturizr |
16,257 |
15,747 |
$74K |
| T4522 |
Adult size brief/diaper med |
383 |
367 |
$36K |
| T4523 |
Adult size brief/diaper lg |
198 |
198 |
$21K |
| A4253 |
Blood glucose/reagent strips |
1,300 |
1,270 |
$11K |
| T4524 |
Adult size brief/diaper xl |
43 |
37 |
$5K |
| A4245 |
Alcohol wipes per box |
1,610 |
1,597 |
$3K |
| B4150 |
Ef complet w/intact nutrient |
12 |
12 |
$3K |
| A4259 |
Lancets per box |
1,273 |
1,263 |
$2K |
| K0004 |
High strength ltwt whlchr |
84 |
84 |
$594.43 |
| A4927 |
Non-sterile gloves |
47 |
45 |
$302.15 |
| A7003 |
Nebulizer administration set |
103 |
102 |
$247.46 |
| K0195 |
Elevating whlchair leg rests |
83 |
83 |
$138.32 |
| A7015 |
Aerosol mask used w nebulize |
115 |
114 |
$99.12 |
| E0260 |
Hosp bed semi-electr w/ matt |
13 |
12 |
$86.60 |
| E0607 |
Blood glucose monitor home |
17 |
17 |
$58.36 |
| A4256 |
Calibrator solution/chips |
36 |
36 |
$40.83 |
| A7004 |
Disposable nebulizer sml vol |
116 |
114 |
$19.59 |
| A4258 |
Lancet device each |
12 |
12 |
$5.04 |
| A4233 |
Alkalin batt for glucose mon |
12 |
12 |
$2.40 |