| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
10,247 |
10,184 |
$361K |
| T4527 |
Adult size pull-on lg |
3,340 |
3,329 |
$339K |
| T4528 |
Adult size pull-on xl |
1,806 |
1,790 |
$245K |
| T4535 |
Disposable liner/shield/pad |
7,630 |
7,531 |
$230K |
| T4526 |
Adult size pull-on med |
2,541 |
2,530 |
$220K |
| E0570 |
Nebulizer with compression |
3,654 |
3,600 |
$114K |
| A4670 |
Automatic bp monitor, dial |
1,060 |
1,054 |
$62K |
| A4335 |
Incontinence supply |
10,913 |
10,801 |
$59K |
| K0001 |
Standard wheelchair |
1,406 |
1,401 |
$13K |
| T4525 |
Adult size pull-on sm |
216 |
210 |
$13K |
| A4253 |
Blood glucose/reagent strips |
1,981 |
1,942 |
$9K |
| E0260 |
Hosp bed semi-electr w/ matt |
270 |
269 |
$3K |
| A7003 |
Nebulizer administration set |
1,083 |
1,055 |
$2K |
| A4617 |
Mouth piece |
554 |
537 |
$1K |
| A7015 |
Aerosol mask used w nebulize |
1,059 |
1,027 |
$1K |
| E0295 |
Hosp bed semi-elect w/o matt |
194 |
193 |
$921.11 |
| A4259 |
Lancets per box |
1,458 |
1,436 |
$555.80 |
| E0143 |
Walker folding wheeled w/o s |
38 |
38 |
$410.48 |
| Q0513 |
Disp fee inhal drugs/30 days |
46 |
45 |
$396.00 |
| E0305 |
Rails bed side half length |
195 |
192 |
$134.29 |
| A7004 |
Disposable nebulizer sml vol |
89 |
89 |
$42.67 |
| E0156 |
Walker seat attachment |
13 |
13 |
$14.52 |
| A7013 |
Disposable compressor filter |
12 |
12 |
$2.80 |
| 90480 |
|
16 |
16 |
$0.00 |
| 90686 |
|
15 |
15 |
$0.00 |
| G0008 |
Admin influenza virus vac |
19 |
19 |
$0.00 |
| J7613 |
Albuterol non-comp unit |
17 |
17 |
$0.00 |
| A5500 |
Diab shoe for density insert |
24 |
12 |
$0.00 |
| 91320 |
|
16 |
16 |
$0.00 |
| A5512 |
Multi den insert direct form |
24 |
12 |
$0.00 |