| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
2,739 |
2,644 |
$284K |
| T4528 |
Adult size pull-on xl |
2,458 |
2,327 |
$283K |
| A4554 |
Disposable underpads |
5,283 |
5,058 |
$246K |
| T4526 |
Adult size pull-on med |
2,000 |
1,933 |
$211K |
| E0570 |
Nebulizer with compression |
4,562 |
3,886 |
$117K |
| A4927 |
Non-sterile gloves |
2,986 |
2,849 |
$114K |
| T4544 |
Adlt disp und/pull on abv xl |
707 |
662 |
$107K |
| K0001 |
Standard wheelchair |
1,967 |
1,650 |
$16K |
| E0143 |
Walker folding wheeled w/o s |
364 |
291 |
$12K |
| A4335 |
Incontinence supply |
1,337 |
1,298 |
$9K |
| A4253 |
Blood glucose/reagent strips |
2,023 |
1,692 |
$8K |
| K0003 |
Lightweight wheelchair |
632 |
535 |
$4K |
| Q0513 |
Disp fee inhal drugs/30 days |
286 |
275 |
$2K |
| 90688 |
|
106 |
101 |
$2K |
| 90471 |
|
136 |
127 |
$2K |
| E0156 |
Walker seat attachment |
295 |
247 |
$2K |
| K0553 |
Ther cgm supply allowance |
83 |
61 |
$2K |
| A7003 |
Nebulizer administration set |
1,126 |
966 |
$2K |
| E0149 |
Heavy duty wheeled walker |
13 |
12 |
$795.81 |
| A5512 |
Multi den insert direct form |
28 |
14 |
$564.35 |
| A5500 |
Diab shoe for density insert |
29 |
14 |
$560.68 |
| A4259 |
Lancets per box |
1,999 |
1,569 |
$500.49 |
| A4670 |
Automatic bp monitor, dial |
12 |
12 |
$440.86 |
| 0011A |
|
17 |
16 |
$392.46 |
| A4239 |
Non-adju cgm supply allow |
62 |
52 |
$318.30 |
| 90686 |
|
16 |
13 |
$234.82 |
| J7620 |
Albuterol ipratrop non-comp |
12 |
12 |
$38.10 |
| A7015 |
Aerosol mask used w nebulize |
19 |
15 |
$29.28 |
| K0195 |
Elevating whlchair leg rests |
14 |
12 |
$22.30 |
| 91301 |
|
21 |
19 |
$0.00 |