| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
2,661 |
2,573 |
$90K |
| X1939 |
|
833 |
829 |
$63K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
421 |
404 |
$30K |
| T5999 |
Supply, not otherwise specified |
3,967 |
3,736 |
$21K |
| E0570 |
Nebulizer, with compressor |
312 |
307 |
$9K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
26 |
26 |
$837.20 |
| K0001 |
Standard wheelchair |
56 |
48 |
$697.50 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
14 |
12 |
$64.68 |