| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult size pull-on xl |
1,637 |
1,620 |
$281K |
| T4541 |
Large disposable underpad |
2,245 |
2,215 |
$144K |
| T4535 |
Disposable liner/shield/pad |
2,247 |
2,215 |
$103K |
| L1833 |
Ko adj jnt pos r sup pre ots |
234 |
174 |
$37K |
| T4527 |
Adult size pull-on lg |
142 |
141 |
$20K |
| T4526 |
Adult size pull-on med |
145 |
142 |
$19K |
| A4927 |
Non-sterile gloves |
2,326 |
2,287 |
$17K |
| A4670 |
Automatic bp monitor, dial |
220 |
216 |
$13K |
| L0650 |
Lso sc r ant/pos pnl pre ots |
30 |
30 |
$5K |
| A5500 |
Diab shoe for density insert |
249 |
154 |
$5K |
| A5512 |
Multi den insert direct form |
250 |
155 |
$5K |
| A5120 |
Skin barrier, wipe or swab |
1,098 |
1,068 |
$4K |
| E0240 |
Bath/shower chair |
16 |
16 |
$2K |
| E0149 |
Heavy duty wheeled walker |
125 |
125 |
$576.76 |
| E0143 |
Walker folding wheeled w/o s |
55 |
55 |
$456.49 |
| E0156 |
Walker seat attachment |
62 |
62 |
$170.83 |
| E0570 |
Nebulizer with compression |
61 |
61 |
$147.92 |