| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Large disposable underpad |
19,128 |
19,071 |
$1.00M |
| T4535 |
Disposable liner/shield/pad |
13,639 |
13,608 |
$537K |
| T4526 |
Adult size pull-on med |
10,570 |
10,543 |
$536K |
| T4527 |
Adult size pull-on lg |
3,032 |
3,024 |
$202K |
| T4525 |
Adult size pull-on sm |
435 |
435 |
$24K |
| E0261 |
Hosp bed semi-electr w/o mat |
1,154 |
1,148 |
$22K |
| T4523 |
Adult size brief/diaper lg |
250 |
250 |
$21K |
| T4522 |
Adult size brief/diaper med |
263 |
262 |
$15K |
| K0003 |
Lightweight wheelchair |
1,150 |
1,147 |
$15K |
| T4536 |
Reusable pull-on any size |
1,152 |
1,150 |
$12K |
| E1038 |
Transport chair pt wt<=300lb |
1,797 |
1,783 |
$9K |
| E0245 |
Tub stool or bench |
182 |
182 |
$9K |
| A5512 |
Multi den insert direct form |
249 |
129 |
$6K |
| E0143 |
Walker folding wheeled w/o s |
209 |
209 |
$3K |
| A6250 |
Skin seal protect moisturizr |
299 |
299 |
$2K |
| A4253 |
Blood glucose/reagent strips |
225 |
211 |
$1K |
| A4335 |
Incontinence supply |
253 |
253 |
$1K |
| L0642 |
Lo sag ri an/pos pnl pre ots |
13 |
13 |
$1K |
| A4259 |
Lancets per box |
225 |
211 |
$862.50 |
| A5500 |
Diab shoe for density insert |
255 |
129 |
$658.94 |
| E0156 |
Walker seat attachment |
37 |
37 |
$440.45 |
| E0570 |
Nebulizer with compression |
171 |
166 |
$387.70 |