| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Large disposable underpad |
10,037 |
9,901 |
$573K |
| T4526 |
Adult size pull-on med |
5,520 |
5,443 |
$294K |
| T4535 |
Disposable liner/shield/pad |
6,741 |
6,653 |
$279K |
| T4527 |
Adult size pull-on lg |
1,621 |
1,610 |
$118K |
| T4525 |
Adult size pull-on sm |
557 |
550 |
$33K |
| A5512 |
Multi den insert direct form |
225 |
147 |
$11K |
| A4253 |
Blood glucose/reagent strips |
1,594 |
1,491 |
$9K |
| E0245 |
Tub stool or bench |
153 |
153 |
$9K |
| A4259 |
Lancets per box |
1,512 |
1,413 |
$4K |
| T4536 |
Reusable pull-on any size |
341 |
341 |
$3K |
| T4522 |
Adult size brief/diaper med |
12 |
12 |
$1K |
| T4523 |
Adult size brief/diaper lg |
12 |
12 |
$879.90 |
| A4256 |
Calibrator solution/chips |
90 |
81 |
$213.96 |
| E0143 |
Walker folding wheeled w/o s |
12 |
12 |
$210.09 |
| E1038 |
Transport chair pt wt<=300lb |
24 |
24 |
$169.82 |
| E0261 |
Hosp bed semi-electr w/o mat |
12 |
12 |
$146.66 |
| A5500 |
Diab shoe for density insert |
228 |
146 |
$132.06 |