| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
19,514 |
19,384 |
$1.15M |
| T4523 |
Adult size brief/diaper lg |
10,813 |
10,767 |
$1.02M |
| T4522 |
Adult size brief/diaper med |
10,283 |
10,228 |
$740K |
| T4524 |
Adult size brief/diaper xl |
6,812 |
6,767 |
$718K |
| T4543 |
Adult disp brief/diap abv xl |
3,217 |
3,211 |
$685K |
| T4535 |
Disposable liner/shield/pad |
13,385 |
13,336 |
$442K |
| T4537 |
Reusable underpad bed size |
8,762 |
8,673 |
$287K |
| T4521 |
Adult size brief/diaper sm |
2,784 |
2,762 |
$202K |
| A4927 |
Non-sterile gloves |
18,243 |
18,175 |
$83K |
| K0001 |
Standard wheelchair |
1,397 |
1,381 |
$46K |
| E0143 |
Walker folding wheeled w/o s |
513 |
513 |
$28K |
| E1390 |
Oxygen concentrator |
263 |
260 |
$15K |
| E0260 |
Hosp bed semi-electr w/ matt |
811 |
789 |
$10K |
| E0240 |
Bath/shower chair |
51 |
50 |
$2K |
| E0163 |
Commode chair with fixed arm |
28 |
28 |
$2K |
| A4351 |
Straight tip urine catheter |
12 |
12 |
$1K |
| A4357 |
Bedside drainage bag |
54 |
54 |
$699.49 |
| A7038 |
Pos airway pressure filter |
67 |
67 |
$149.08 |