| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0553 |
Ther cgm supply allowance |
6,422 |
6,417 |
$709K |
| T4535 |
Disposable liner/shield/pad |
23,608 |
23,424 |
$706K |
| A4554 |
Disposable underpads |
18,832 |
18,640 |
$648K |
| T4523 |
Adult size brief/diaper lg |
6,390 |
6,337 |
$469K |
| A4239 |
Non-adju cgm supply allow |
7,361 |
7,212 |
$320K |
| T4524 |
Adult size brief/diaper xl |
3,436 |
3,407 |
$271K |
| T4522 |
Adult size brief/diaper med |
4,077 |
4,013 |
$241K |
| T4539 |
Reuse diaper/brief any size |
6,980 |
6,856 |
$198K |
| A4238 |
Adju cgm supply allowance |
2,340 |
2,288 |
$174K |
| L3030 |
Foot arch support remov prem |
2,681 |
1,463 |
$171K |
| T4537 |
Reusable underpad bed size |
3,554 |
3,490 |
$108K |
| A9274 |
Ext amb insulin delivery sys |
38 |
38 |
$79K |
| A9276 |
Disposable sensor, cgm sys |
472 |
458 |
$78K |
| L3216 |
Orthoped ladies shoes dpth i |
1,298 |
746 |
$60K |
| A4927 |
Non-sterile gloves |
9,231 |
9,058 |
$41K |
| K0554 |
Ther cgm receiver/monitor |
386 |
386 |
$41K |
| A5500 |
Diab shoe for density insert |
772 |
516 |
$34K |
| L3221 |
Orthopedic mens shoes dpth i |
590 |
334 |
$32K |
| T4543 |
Adult disp brief/diap abv xl |
235 |
235 |
$31K |
| E2103 |
Non-adju cgm receiver/mon |
422 |
416 |
$19K |
| L8020 |
Mastectomy form |
172 |
141 |
$18K |
| A5512 |
Multi den insert direct form |
635 |
417 |
$16K |
| L8030 |
Breast prosthes w/o adhesive |
129 |
105 |
$15K |
| A9277 |
External transmitter, cgm |
148 |
148 |
$14K |
| E0601 |
Cont airway pressure device |
601 |
594 |
$13K |
| L8000 |
Mastectomy bra |
329 |
252 |
$10K |
| S8101 |
Spacer with mask |
153 |
151 |
$8K |
| T4540 |
Reusable underpad chair size |
527 |
507 |
$7K |
| A4402 |
Lubricant per ounce |
1,058 |
1,040 |
$6K |
| K0001 |
Standard wheelchair |
531 |
527 |
$4K |
| E0562 |
Humidifier heated used w pap |
216 |
215 |
$3K |
| E0570 |
Nebulizer with compression |
163 |
163 |
$2K |
| A7005 |
Nondisposable nebulizer set |
156 |
153 |
$2K |
| A6530 |
Compression stocking bk18-30 |
95 |
51 |
$2K |
| E1399 |
Durable medical equipment mi |
245 |
245 |
$1K |
| E0143 |
Walker folding wheeled w/o s |
52 |
52 |
$926.42 |
| K0195 |
Elevating whlchair leg rests |
463 |
461 |
$838.76 |
| E0261 |
Hosp bed semi-electr w/o mat |
37 |
37 |
$805.04 |
| E0260 |
Hosp bed semi-electr w/ matt |
24 |
24 |
$494.78 |
| E2102 |
Adju cgm receiver/monitor |
12 |
12 |
$410.71 |
| A7038 |
Pos airway pressure filter |
163 |
159 |
$281.60 |
| A7035 |
Pos airway press headgear |
57 |
55 |
$273.59 |
| A7037 |
Pos airway pressure tubing |
70 |
68 |
$258.98 |
| A4335 |
Incontinence supply |
42 |
42 |
$218.40 |
| E0156 |
Walker seat attachment |
43 |
43 |
$202.11 |
| A7034 |
Nasal application device |
16 |
14 |
$136.94 |
| A7015 |
Aerosol mask used w nebulize |
15 |
15 |
$16.05 |