| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
22,695 |
22,335 |
$758K |
| T4527 |
Adult size pull-on lg |
5,505 |
5,397 |
$636K |
| T4526 |
Adult size pull-on med |
5,510 |
5,428 |
$576K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
2,809 |
2,734 |
$494K |
| T4535 |
Disposable liner/shield/pad |
11,449 |
10,950 |
$436K |
| T4528 |
Adult size pull-on xl |
2,294 |
2,246 |
$392K |
| T4534 |
Youth size pull-on |
2,967 |
2,875 |
$312K |
| E0570 |
Nebulizer with compression |
1,454 |
1,442 |
$172K |
| T4532 |
Ped size pull-on lg |
1,232 |
1,201 |
$165K |
| A4335 |
Incontinence supply |
27,183 |
26,903 |
$149K |
| T4525 |
Adult size pull-on sm |
767 |
737 |
$68K |
| T4533 |
Youth size brief/diaper |
645 |
625 |
$58K |
| L3000 |
Ft insert ucb berkeley shell |
426 |
210 |
$57K |
| T4522 |
Adult size brief/diaper med |
484 |
467 |
$49K |
| K0001 |
Standard wheelchair |
2,086 |
2,039 |
$37K |
| A4253 |
Blood glucose/reagent strips |
657 |
630 |
$24K |
| T4523 |
Adult size brief/diaper lg |
223 |
223 |
$22K |
| L3020 |
Foot longitud/metatarsal sup |
239 |
117 |
$21K |
| K0195 |
Elevating whlchair leg rests |
2,200 |
2,153 |
$15K |
| A7002 |
Tubing used w suction pump |
1,421 |
1,406 |
$5K |
| A4259 |
Lancets per box |
459 |
451 |
$4K |
| A7005 |
Nondisposable nebulizer set |
137 |
137 |
$3K |
| A7015 |
Aerosol mask used w nebulize |
1,411 |
1,397 |
$2K |
| A5500 |
Diab shoe for density insert |
636 |
416 |
$2K |
| A7004 |
Disposable nebulizer sml vol |
1,266 |
1,254 |
$2K |
| A4245 |
Alcohol wipes per box |
665 |
648 |
$1K |
| A7013 |
Disposable compressor filter |
1,241 |
1,227 |
$1K |
| A5513 |
Multi den insert custom mold |
225 |
166 |
$307.76 |