| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Large disposable underpad |
12,863 |
11,807 |
$531K |
| T4527 |
Adult size pull-on lg |
4,475 |
4,178 |
$502K |
| T4535 |
Disposable liner/shield/pad |
9,036 |
8,270 |
$429K |
| T4526 |
Adult size pull-on med |
3,304 |
2,985 |
$366K |
| T4528 |
Adult size pull-on xl |
2,519 |
2,388 |
$284K |
| A4927 |
Non-sterile gloves |
12,218 |
11,168 |
$158K |
| T4534 |
Youth size pull-on |
960 |
864 |
$121K |
| A4253 |
Blood glucose/reagent strips |
3,885 |
3,605 |
$93K |
| A4670 |
Automatic bp monitor, dial |
1,033 |
870 |
$54K |
| T4530 |
Ped size brief/diaper lg |
364 |
349 |
$46K |
| T4523 |
Adult size brief/diaper lg |
320 |
280 |
$33K |
| E0570 |
Nebulizer with compression |
999 |
844 |
$31K |
| A6530 |
Compression stocking bk18-30 |
298 |
253 |
$20K |
| A4259 |
Lancets per box |
3,846 |
3,583 |
$13K |
| A7005 |
Nondisposable nebulizer set |
511 |
430 |
$7K |
| T4544 |
Adlt disp und/pull on abv xl |
24 |
24 |
$5K |
| E0607 |
Blood glucose monitor home |
76 |
76 |
$3K |
| A5500 |
Diab shoe for density insert |
70 |
50 |
$2K |
| T4524 |
Adult size brief/diaper xl |
17 |
14 |
$2K |
| A5512 |
Multi den insert direct form |
70 |
50 |
$2K |
| A4258 |
Lancet device each |
76 |
75 |
$777.94 |
| K0195 |
Elevating whlchair leg rests |
106 |
74 |
$630.07 |
| A7015 |
Aerosol mask used w nebulize |
489 |
414 |
$622.38 |
| A4256 |
Calibrator solution/chips |
26 |
26 |
$165.02 |
| K0001 |
Standard wheelchair |
28 |
25 |
$113.05 |