| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult size pull-on xl |
1,197 |
1,179 |
$143K |
| T4541 |
Large disposable underpad |
1,330 |
1,280 |
$105K |
| T4526 |
Adult size pull-on med |
727 |
706 |
$94K |
| T4527 |
Adult size pull-on lg |
350 |
346 |
$47K |
| T4535 |
Disposable liner/shield/pad |
1,158 |
1,125 |
$27K |
| E0603 |
Electric breast pump |
108 |
106 |
$13K |
| T4523 |
Adult size brief/diaper lg |
69 |
67 |
$10K |
| T4544 |
Adlt disp und/pull on abv xl |
52 |
52 |
$6K |
| E0570 |
Nebulizer with compression |
158 |
154 |
$6K |
| B4152 |
Ef calorie dense>/=1.5kcal |
25 |
25 |
$4K |
| E0973 |
W/ch access det adj armrest |
242 |
118 |
$2K |
| E1390 |
Oxygen concentrator |
27 |
24 |
$1K |
| K0739 |
Repair/svc dme non-oxygen eq |
41 |
37 |
$384.46 |
| A4927 |
Non-sterile gloves |
12 |
12 |
$380.85 |
| E1028 |
W/c manual swingaway |
28 |
24 |
$358.96 |
| A7003 |
Nebulizer administration set |
25 |
25 |
$81.05 |