| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4542 |
Small disposable underpad |
8,592 |
7,924 |
$329K |
| T4527 |
Adult size pull-on lg |
2,698 |
2,440 |
$296K |
| T4526 |
Adult size pull-on med |
2,950 |
2,597 |
$271K |
| T4535 |
Disposable liner/shield/pad |
4,231 |
3,974 |
$240K |
| T4528 |
Adult size pull-on xl |
1,700 |
1,574 |
$219K |
| T4543 |
Adult disp brief/diap abv xl |
743 |
706 |
$204K |
| E1390 |
Oxygen concentrator |
3,664 |
2,732 |
$135K |
| B4150 |
Ef complet w/intact nutrient |
1,378 |
965 |
$125K |
| E0260 |
Hosp bed semi-electr w/ matt |
789 |
568 |
$36K |
| E0431 |
Portable gaseous 02 |
2,004 |
1,605 |
$31K |
| A4927 |
Non-sterile gloves |
1,728 |
1,516 |
$24K |
| T4525 |
Adult size pull-on sm |
153 |
138 |
$13K |
| K0001 |
Standard wheelchair |
633 |
487 |
$12K |
| E0570 |
Nebulizer with compression |
1,581 |
1,353 |
$9K |
| B4154 |
Ef spec metabolic noninherit |
46 |
26 |
$7K |
| E0601 |
Cont airway pressure device |
317 |
250 |
$6K |
| E0971 |
Wheelchair anti-tipping devi |
1,640 |
604 |
$2K |
| T4537 |
Reusable underpad bed size |
18 |
18 |
$2K |
| A6402 |
Sterile gauze <= 16 sq in |
191 |
136 |
$1K |
| A4670 |
Automatic bp monitor, dial |
32 |
24 |
$940.00 |
| A4253 |
Blood glucose/reagent strips |
70 |
50 |
$355.65 |
| A6446 |
Conform band s w>=3" <5"/yd |
26 |
24 |
$301.32 |
| E0143 |
Walker folding wheeled w/o s |
15 |
13 |
$299.20 |
| A5500 |
Diab shoe for density insert |
59 |
14 |
$184.28 |
| A5512 |
Multi den insert direct form |
57 |
13 |
$75.20 |
| A7003 |
Nebulizer administration set |
40 |
24 |
$62.19 |
| A7038 |
Pos airway pressure filter |
16 |
12 |
$23.15 |