| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
44,296 |
42,234 |
$2.80M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
17,335 |
16,546 |
$2.61M |
| A4927 |
Gloves, non-sterile, per 100 |
49,229 |
47,077 |
$2.10M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
12,445 |
11,957 |
$1.76M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
10,321 |
9,883 |
$1.55M |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
3,859 |
3,697 |
$665K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,250 |
1,193 |
$178K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,011 |
970 |
$140K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
627 |
622 |
$134K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
506 |
487 |
$72K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
2,175 |
1,447 |
$15K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,187 |
626 |
$15K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
2,210 |
1,476 |
$13K |
| K0003 |
Lightweight wheelchair |
1,697 |
875 |
$12K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
120 |
116 |
$6K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
192 |
151 |
$511.45 |
| E0607 |
Home blood glucose monitor |
82 |
52 |
$475.60 |
| A4335 |
Incontinence supply; miscellaneous |
228 |
207 |
$101.40 |
| A4259 |
Lancets, per box of 100 |
177 |
136 |
$38.88 |
| A4256 |
Normal, low and high calibrator solution / chips |
111 |
99 |
$23.12 |