| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
15,596 |
15,451 |
$552K |
| T4527 |
Adult size pull-on lg |
4,509 |
4,483 |
$496K |
| T4526 |
Adult size pull-on med |
3,705 |
3,677 |
$322K |
| T4535 |
Disposable liner/shield/pad |
7,530 |
7,404 |
$248K |
| T4528 |
Adult size pull-on xl |
1,730 |
1,721 |
$218K |
| A4335 |
Incontinence supply |
17,681 |
17,449 |
$93K |
| B4034 |
Enter feed supkit syr by day |
915 |
903 |
$23K |
| T4523 |
Adult size brief/diaper lg |
219 |
218 |
$22K |
| E0570 |
Nebulizer with compression |
982 |
965 |
$20K |
| B4150 |
Ef complet w/intact nutrient |
249 |
244 |
$17K |
| E0260 |
Hosp bed semi-electr w/ matt |
393 |
390 |
$6K |
| T4525 |
Adult size pull-on sm |
73 |
72 |
$5K |
| T4522 |
Adult size brief/diaper med |
50 |
50 |
$5K |
| A4253 |
Blood glucose/reagent strips |
1,052 |
1,044 |
$4K |
| T4532 |
Ped size pull-on lg |
36 |
36 |
$3K |
| K0001 |
Standard wheelchair |
419 |
419 |
$3K |
| A4670 |
Automatic bp monitor, dial |
25 |
25 |
$2K |
| T4534 |
Youth size pull-on |
13 |
13 |
$917.47 |
| E0601 |
Cont airway pressure device |
28 |
26 |
$601.11 |
| A7037 |
Pos airway pressure tubing |
27 |
27 |
$263.60 |
| A7003 |
Nebulizer administration set |
200 |
195 |
$261.27 |
| A4259 |
Lancets per box |
522 |
520 |
$210.94 |
| A7015 |
Aerosol mask used w nebulize |
197 |
193 |
$152.48 |
| A4617 |
Mouth piece |
57 |
56 |
$101.36 |
| A7038 |
Pos airway pressure filter |
26 |
26 |
$70.87 |
| A4535 |
|
13 |
13 |
$0.00 |