| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
50,343 |
47,945 |
$1.70M |
| X1939 |
|
22,430 |
22,283 |
$1.40M |
| T5999 |
Supply, nos |
104,405 |
92,874 |
$1.01M |
| T4527 |
Adult size pull-on lg |
17,018 |
16,018 |
$929K |
| T4528 |
Adult size pull-on xl |
12,663 |
11,944 |
$881K |
| T4543 |
Adult disp brief/diap abv xl |
5,721 |
5,262 |
$757K |
| T4534 |
Youth size pull-on |
6,726 |
6,505 |
$688K |
| T4526 |
Adult size pull-on med |
12,846 |
11,999 |
$673K |
| T4535 |
Disposable liner/shield/pad |
18,445 |
17,970 |
$563K |
| T4522 |
Adult size brief/diaper med |
5,832 |
4,893 |
$488K |
| T2028 |
Special supply, nos waiver |
4,060 |
3,669 |
$450K |
| S5161 |
Emer rspns sys serv permonth |
13,331 |
13,283 |
$399K |
| T4523 |
Adult size brief/diaper lg |
3,964 |
3,371 |
$379K |
| T4524 |
Adult size brief/diaper xl |
2,467 |
2,275 |
$286K |
| T4530 |
Ped size brief/diaper lg |
2,726 |
2,662 |
$268K |
| A4927 |
Non-sterile gloves |
10,571 |
5,972 |
$132K |
| T4521 |
Adult size brief/diaper sm |
994 |
931 |
$115K |
| T4525 |
Adult size pull-on sm |
988 |
981 |
$69K |
| T4533 |
Youth size brief/diaper |
532 |
518 |
$55K |
| X1922 |
|
239 |
217 |
$34K |
| X1915 |
|
290 |
279 |
$25K |
| E0260 |
Hosp bed semi-electr w/ matt |
484 |
311 |
$19K |
| E0244 |
Toilet seat raised |
184 |
182 |
$18K |
| E0240 |
Bath/shower chair |
269 |
268 |
$17K |
| T4529 |
Ped size brief/diaper sm/med |
79 |
75 |
$9K |
| E0570 |
Nebulizer with compression |
537 |
341 |
$9K |
| T4532 |
Ped size pull-on lg |
79 |
79 |
$6K |
| E0247 |
Trans bench w/wo comm open |
13 |
13 |
$2K |
| A4322 |
Irrigation syringe |
35 |
12 |
$2K |
| K0001 |
Standard wheelchair |
67 |
36 |
$1K |