| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
44,296 |
42,234 |
$2.80M |
| T4527 |
Adult size pull-on lg |
17,335 |
16,546 |
$2.61M |
| A4927 |
Non-sterile gloves |
49,229 |
47,077 |
$2.10M |
| T4526 |
Adult size pull-on med |
12,445 |
11,957 |
$1.76M |
| T4528 |
Adult size pull-on xl |
10,321 |
9,883 |
$1.55M |
| T4543 |
Adult disp brief/diap abv xl |
3,859 |
3,697 |
$665K |
| T4523 |
Adult size brief/diaper lg |
1,250 |
1,193 |
$178K |
| T4525 |
Adult size pull-on sm |
1,011 |
970 |
$140K |
| T4544 |
Adlt disp und/pull on abv xl |
627 |
622 |
$134K |
| T4524 |
Adult size brief/diaper xl |
506 |
487 |
$72K |
| A5512 |
Multi den insert direct form |
2,175 |
1,447 |
$15K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,187 |
626 |
$15K |
| A5500 |
Diab shoe for density insert |
2,210 |
1,476 |
$13K |
| K0003 |
Lightweight wheelchair |
1,697 |
875 |
$12K |
| K0553 |
Ther cgm supply allowance |
120 |
116 |
$6K |
| A4253 |
Blood glucose/reagent strips |
192 |
151 |
$511.45 |
| E0607 |
Blood glucose monitor home |
82 |
52 |
$475.60 |
| A4335 |
Incontinence supply |
228 |
207 |
$101.40 |
| A4259 |
Lancets per box |
177 |
136 |
$38.88 |
| A4256 |
Calibrator solution/chips |
111 |
99 |
$23.12 |