| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4245 |
Alcohol wipes per box |
5,627 |
5,586 |
$107K |
| A4554 |
Disposable underpads |
2,650 |
2,619 |
$107K |
| T4526 |
Adult size pull-on med |
2,080 |
2,066 |
$105K |
| T4528 |
Adult size pull-on xl |
1,351 |
1,329 |
$97K |
| T4527 |
Adult size pull-on lg |
1,636 |
1,608 |
$90K |
| T4524 |
Adult size brief/diaper xl |
977 |
967 |
$84K |
| T4535 |
Disposable liner/shield/pad |
1,371 |
1,362 |
$65K |
| T4541 |
Large disposable underpad |
1,288 |
1,277 |
$41K |
| E1390 |
Oxygen concentrator |
447 |
310 |
$22K |
| A4927 |
Non-sterile gloves |
3,292 |
3,253 |
$19K |
| A6250 |
Skin seal protect moisturizr |
1,700 |
1,673 |
$13K |
| T4523 |
Adult size brief/diaper lg |
264 |
259 |
$13K |
| K0001 |
Standard wheelchair |
1,790 |
926 |
$10K |
| E0260 |
Hosp bed semi-electr w/ matt |
438 |
264 |
$5K |
| E0431 |
Portable gaseous 02 |
420 |
300 |
$2K |
| T4522 |
Adult size brief/diaper med |
12 |
12 |
$698.86 |
| T4540 |
Reusable underpad chair size |
64 |
64 |
$568.00 |
| K0195 |
Elevating whlchair leg rests |
25 |
24 |
$142.24 |
| E0570 |
Nebulizer with compression |
92 |
20 |
$120.58 |