| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4154 |
Ef spec metabolic noninherit |
729 |
725 |
$111K |
| T4527 |
Adult size pull-on lg |
809 |
809 |
$81K |
| A4554 |
Disposable underpads |
2,271 |
2,267 |
$79K |
| T4528 |
Adult size pull-on xl |
561 |
561 |
$71K |
| B4152 |
Ef calorie dense>/=1.5kcal |
504 |
502 |
$67K |
| T4526 |
Adult size pull-on med |
422 |
422 |
$34K |
| A6533 |
Gc stocking thighlngth 18-30 |
236 |
236 |
$28K |
| A6530 |
Compression stocking bk18-30 |
293 |
293 |
$25K |
| B4150 |
Ef complet w/intact nutrient |
291 |
290 |
$23K |
| T4523 |
Adult size brief/diaper lg |
218 |
218 |
$21K |
| T4524 |
Adult size brief/diaper xl |
159 |
158 |
$17K |
| A4927 |
Non-sterile gloves |
996 |
994 |
$14K |
| E0570 |
Nebulizer with compression |
145 |
145 |
$11K |
| A4670 |
Automatic bp monitor, dial |
67 |
67 |
$2K |
| E0245 |
Tub stool or bench |
12 |
12 |
$868.00 |
| E0143 |
Walker folding wheeled w/o s |
13 |
13 |
$492.34 |
| A7003 |
Nebulizer administration set |
118 |
118 |
$131.58 |
| A7015 |
Aerosol mask used w nebulize |
118 |
118 |
$116.00 |
| E0156 |
Walker seat attachment |
13 |
13 |
$93.47 |