| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Large disposable underpad |
5,072 |
4,996 |
$268K |
| T4526 |
Adult size pull-on med |
4,533 |
4,468 |
$252K |
| A4239 |
Non-adju cgm supply allow |
1,461 |
1,392 |
$144K |
| T4527 |
Adult size pull-on lg |
1,383 |
1,368 |
$105K |
| T4525 |
Adult size pull-on sm |
1,823 |
1,799 |
$94K |
| K0001 |
Standard wheelchair |
1,477 |
1,475 |
$35K |
| E0245 |
Tub stool or bench |
601 |
601 |
$34K |
| E0143 |
Walker folding wheeled w/o s |
1,222 |
1,221 |
$27K |
| T4535 |
Disposable liner/shield/pad |
646 |
638 |
$26K |
| K0003 |
Lightweight wheelchair |
709 |
705 |
$26K |
| T4523 |
Adult size brief/diaper lg |
197 |
195 |
$18K |
| E0570 |
Nebulizer with compression |
1,276 |
1,273 |
$17K |
| L1812 |
Ko elastic w/joints pre ots |
622 |
369 |
$15K |
| T4522 |
Adult size brief/diaper med |
222 |
221 |
$14K |
| E1038 |
Transport chair pt wt<=300lb |
1,933 |
1,930 |
$9K |
| T4528 |
Adult size pull-on xl |
106 |
105 |
$7K |
| E0156 |
Walker seat attachment |
984 |
981 |
$6K |
| A4253 |
Blood glucose/reagent strips |
804 |
768 |
$6K |
| E0105 |
Cane adjust/fixed quad/3 pro |
322 |
321 |
$5K |
| T4542 |
Small disposable underpad |
114 |
114 |
$5K |
| E0159 |
Brake for wheeled walker |
794 |
792 |
$3K |
| L0625 |
Lo flex l1-below l5 pre ots |
180 |
180 |
$2K |
| E0163 |
Commode chair with fixed arm |
53 |
53 |
$1K |
| E0295 |
Hosp bed semi-elect w/o matt |
102 |
102 |
$1K |
| K0553 |
Ther cgm supply allowance |
26 |
26 |
$1K |
| A4259 |
Lancets per box |
789 |
753 |
$871.72 |
| A5061 |
Pouch drainable w barrier at |
24 |
24 |
$493.25 |
| L1810 |
Ko elastic with joints |
27 |
15 |
$326.51 |
| E0310 |
Rails bed side full length |
42 |
42 |
$104.02 |
| A4927 |
Non-sterile gloves |
14 |
13 |
$46.18 |
| A7015 |
Aerosol mask used w nebulize |
42 |
42 |
$20.60 |
| A7003 |
Nebulizer administration set |
14 |
14 |
$17.56 |