| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
14,985 |
14,960 |
$1.88M |
| A4554 |
Disposable underpads |
41,836 |
41,796 |
$1.57M |
| T4526 |
Adult size pull-on med |
11,654 |
11,645 |
$1.28M |
| T4535 |
Disposable liner/shield/pad |
24,523 |
24,063 |
$934K |
| T4528 |
Adult size pull-on xl |
6,058 |
6,050 |
$886K |
| A4335 |
Incontinence supply |
46,494 |
46,452 |
$258K |
| T4523 |
Adult size brief/diaper lg |
1,220 |
1,218 |
$136K |
| T4532 |
Ped size pull-on lg |
825 |
816 |
$125K |
| T4525 |
Adult size pull-on sm |
1,059 |
1,058 |
$100K |
| T4524 |
Adult size brief/diaper xl |
634 |
633 |
$88K |
| T4544 |
Adlt disp und/pull on abv xl |
350 |
349 |
$72K |
| T4522 |
Adult size brief/diaper med |
708 |
706 |
$70K |
| A4253 |
Blood glucose/reagent strips |
5,075 |
5,004 |
$53K |
| E0570 |
Nebulizer with compression |
1,425 |
1,413 |
$39K |
| A4670 |
Automatic bp monitor, dial |
536 |
532 |
$32K |
| A6250 |
Skin seal protect moisturizr |
6,133 |
6,129 |
$30K |
| E0240 |
Bath/shower chair |
109 |
109 |
$28K |
| K0001 |
Standard wheelchair |
1,615 |
1,603 |
$25K |
| E0260 |
Hosp bed semi-electr w/ matt |
693 |
692 |
$20K |
| A6530 |
Compression stocking bk18-30 |
99 |
94 |
$11K |
| A4259 |
Lancets per box |
4,548 |
4,511 |
$8K |
| S8101 |
Spacer with mask |
264 |
262 |
$7K |
| A5500 |
Diab shoe for density insert |
720 |
465 |
$2K |
| K0003 |
Lightweight wheelchair |
80 |
80 |
$917.96 |
| E0143 |
Walker folding wheeled w/o s |
41 |
41 |
$832.04 |
| A4245 |
Alcohol wipes per box |
462 |
462 |
$739.49 |
| A7003 |
Nebulizer administration set |
462 |
451 |
$710.75 |
| A5512 |
Multi den insert direct form |
452 |
311 |
$605.81 |
| A7015 |
Aerosol mask used w nebulize |
549 |
537 |
$580.73 |
| E0156 |
Walker seat attachment |
40 |
40 |
$98.95 |
| A4258 |
Lancet device each |
88 |
87 |
$76.18 |