| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
6,506 |
6,237 |
$609K |
| B4150 |
Ef complet w/intact nutrient |
5,978 |
5,668 |
$581K |
| A4554 |
Disposable underpads |
14,987 |
14,476 |
$539K |
| B4154 |
Ef spec metabolic noninherit |
4,243 |
4,060 |
$533K |
| E1390 |
Oxygen concentrator |
5,061 |
4,110 |
$351K |
| S5161 |
Emer rspns sys serv permonth |
11,973 |
11,552 |
$338K |
| T4528 |
Adult size pull-on xl |
3,596 |
3,483 |
$318K |
| T4526 |
Adult size pull-on med |
3,606 |
3,471 |
$269K |
| T4535 |
Disposable liner/shield/pad |
6,942 |
6,704 |
$218K |
| E0570 |
Nebulizer with compression |
3,416 |
2,559 |
$179K |
| T4544 |
Adlt disp und/pull on abv xl |
1,159 |
1,119 |
$158K |
| A4927 |
Non-sterile gloves |
8,590 |
8,390 |
$149K |
| E0601 |
Cont airway pressure device |
1,551 |
1,206 |
$67K |
| S5165 |
Home modifications per serv |
79 |
64 |
$60K |
| T4525 |
Adult size pull-on sm |
677 |
643 |
$47K |
| T2025 |
Waiver service, nos |
1,802 |
1,660 |
$31K |
| E0431 |
Portable gaseous 02 |
2,391 |
1,885 |
$27K |
| K0001 |
Standard wheelchair |
2,261 |
1,421 |
$17K |
| A4335 |
Incontinence supply |
1,798 |
1,740 |
$14K |
| A7005 |
Nondisposable nebulizer set |
489 |
425 |
$11K |
| E0265 |
Hosp bed total electr w/ mat |
191 |
158 |
$8K |
| E0260 |
Hosp bed semi-electr w/ matt |
398 |
280 |
$7K |
| E1392 |
Portable oxygen concentrator |
433 |
353 |
$6K |
| A4627 |
Spacer bag/reservoir |
198 |
158 |
$6K |
| A4253 |
Blood glucose/reagent strips |
3,026 |
1,538 |
$5K |
| T4523 |
Adult size brief/diaper lg |
41 |
37 |
$3K |
| K0003 |
Lightweight wheelchair |
91 |
66 |
$3K |
| A7003 |
Nebulizer administration set |
1,268 |
1,005 |
$2K |
| T4534 |
Youth size pull-on |
17 |
12 |
$2K |
| T4524 |
Adult size brief/diaper xl |
17 |
12 |
$1K |
| K0195 |
Elevating whlchair leg rests |
207 |
119 |
$1K |
| A4259 |
Lancets per box |
1,513 |
879 |
$232.33 |
| A7038 |
Pos airway pressure filter |
44 |
36 |
$105.55 |
| J7613 |
Albuterol non-comp unit |
100 |
52 |
$66.68 |
| Q0513 |
Disp fee inhal drugs/30 days |
17 |
12 |
$52.80 |