| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6549 |
Grad com garm noc day use |
4,147 |
2,428 |
$523K |
| T4541 |
Large disposable underpad |
2,850 |
2,825 |
$166K |
| E1399 |
Durable medical equipment mi |
1,867 |
1,556 |
$146K |
| T4527 |
Adult size pull-on lg |
1,749 |
1,739 |
$145K |
| T4535 |
Disposable liner/shield/pad |
2,298 |
2,252 |
$142K |
| A4670 |
Automatic bp monitor, dial |
1,266 |
1,266 |
$126K |
| T4526 |
Adult size pull-on med |
1,536 |
1,529 |
$98K |
| T5999 |
Supply, nos |
2,109 |
1,968 |
$85K |
| E0603 |
Electric breast pump |
250 |
250 |
$68K |
| E0295 |
Hosp bed semi-elect w/o matt |
767 |
767 |
$65K |
| K0001 |
Standard wheelchair |
1,781 |
1,778 |
$50K |
| L3908 |
Who cock-up nonmolde pre ots |
1,241 |
869 |
$49K |
| A4927 |
Non-sterile gloves |
878 |
846 |
$47K |
| E0570 |
Nebulizer with compression |
1,336 |
1,333 |
$33K |
| L2999 |
Lower extremity orthosis nos |
70 |
50 |
$16K |
| L1820 |
Ko elas w/ condyle pads & jo |
165 |
156 |
$11K |
| A4357 |
Bedside drainage bag |
258 |
213 |
$3K |
| A5500 |
Diab shoe for density insert |
151 |
88 |
$3K |
| L0621 |
Sio flex pelvic/sacr pre ots |
50 |
50 |
$3K |
| E0143 |
Walker folding wheeled w/o s |
52 |
52 |
$2K |
| L4350 |
Ankle control ortho pre ots |
26 |
26 |
$2K |
| A9276 |
Disposable sensor, cgm sys |
12 |
12 |
$2K |
| A7005 |
Nondisposable nebulizer set |
37 |
37 |
$1K |
| L4386 |
Non-pneum walk boot pre cst |
15 |
14 |
$1K |
| T4525 |
Adult size pull-on sm |
13 |
13 |
$906.54 |
| A9900 |
Supply/accessory/service |
33 |
33 |
$894.07 |
| T4528 |
Adult size pull-on xl |
12 |
12 |
$839.51 |
| E0260 |
Hosp bed semi-electr w/ matt |
193 |
193 |
$680.64 |
| A5512 |
Multi den insert direct form |
26 |
13 |
$310.08 |
| E0156 |
Walker seat attachment |
12 |
12 |
$145.83 |
| A4253 |
Blood glucose/reagent strips |
28 |
24 |
$136.47 |
| A7015 |
Aerosol mask used w nebulize |
36 |
36 |
$60.83 |
| E0271 |
Mattress innerspring |
73 |
73 |
$0.00 |
| E0305 |
Rails bed side half length |
74 |
74 |
$0.00 |