| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Large disposable underpad |
23,727 |
23,541 |
$1.62M |
| T4528 |
Adult size pull-on xl |
11,290 |
11,179 |
$1.61M |
| T4535 |
Disposable liner/shield/pad |
27,733 |
27,501 |
$1.37M |
| T4527 |
Adult size pull-on lg |
10,025 |
9,940 |
$1.16M |
| T4526 |
Adult size pull-on med |
3,499 |
3,469 |
$384K |
| A4927 |
Non-sterile gloves |
14,927 |
14,757 |
$205K |
| T4544 |
Adlt disp und/pull on abv xl |
181 |
175 |
$49K |
| T4524 |
Adult size brief/diaper xl |
316 |
311 |
$27K |
| A5500 |
Diab shoe for density insert |
308 |
222 |
$12K |
| K0001 |
Standard wheelchair |
585 |
584 |
$8K |
| A5512 |
Multi den insert direct form |
266 |
195 |
$7K |
| E0570 |
Nebulizer with compression |
1,549 |
1,549 |
$2K |
| A4670 |
Automatic bp monitor, dial |
24 |
24 |
$1K |
| A6539 |
Gc stocking waistlngth 18-30 |
14 |
14 |
$1K |
| A6530 |
Compression stocking bk18-30 |
12 |
12 |
$707.06 |
| A7003 |
Nebulizer administration set |
12 |
12 |
$11.39 |
| A7013 |
Disposable compressor filter |
12 |
12 |
$3.14 |