| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
3,201 |
3,189 |
$370K |
| A4554 |
Disposable underpads |
9,855 |
9,775 |
$351K |
| T4528 |
Adult size pull-on xl |
1,806 |
1,779 |
$274K |
| T4535 |
Disposable liner/shield/pad |
7,227 |
6,661 |
$264K |
| T4526 |
Adult size pull-on med |
1,982 |
1,977 |
$215K |
| E1390 |
Oxygen concentrator |
2,510 |
2,493 |
$141K |
| A4335 |
Incontinence supply |
14,912 |
14,667 |
$82K |
| E1399 |
Durable medical equipment mi |
43 |
40 |
$31K |
| E0260 |
Hosp bed semi-electr w/ matt |
807 |
807 |
$20K |
| A4253 |
Blood glucose/reagent strips |
853 |
809 |
$18K |
| E0431 |
Portable gaseous 02 |
1,280 |
1,264 |
$16K |
| K0002 |
Stnd hemi (low seat) whlchr |
259 |
257 |
$9K |
| E0601 |
Cont airway pressure device |
89 |
87 |
$4K |
| A4259 |
Lancets per box |
834 |
804 |
$3K |
| E0570 |
Nebulizer with compression |
678 |
678 |
$2K |
| K0001 |
Standard wheelchair |
274 |
274 |
$2K |
| T4524 |
Adult size brief/diaper xl |
12 |
12 |
$2K |
| K0738 |
Portable gas oxygen system |
533 |
531 |
$1K |