| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult size pull-on xl |
11,917 |
11,091 |
$734K |
| T4535 |
Disposable liner/shield/pad |
18,425 |
16,063 |
$652K |
| A0100 |
Nonemergency transport taxi |
6,000 |
5,025 |
$638K |
| T4527 |
Adult size pull-on lg |
13,125 |
12,098 |
$638K |
| T2028 |
Special supply, nos waiver |
7,939 |
6,669 |
$522K |
| T4544 |
Adlt disp und/pull on abv xl |
5,548 |
5,033 |
$506K |
| B4150 |
Ef complet w/intact nutrient |
4,950 |
3,624 |
$444K |
| T4526 |
Adult size pull-on med |
9,798 |
9,038 |
$421K |
| A0090 |
Interest escort in non er |
3,063 |
2,828 |
$242K |
| B4152 |
Ef calorie dense>/=1.5kcal |
2,029 |
1,512 |
$226K |
| T2003 |
N-et; encounter/trip |
1,898 |
1,643 |
$219K |
| A0110 |
Nonemergency transport bus |
3,324 |
3,206 |
$173K |
| T1999 |
Noc retail items andsupplies |
2,003 |
1,643 |
$170K |
| T4523 |
Adult size brief/diaper lg |
1,784 |
1,649 |
$148K |
| T4541 |
Large disposable underpad |
4,260 |
3,922 |
$110K |
| A4335 |
Incontinence supply |
7,172 |
6,570 |
$100K |
| T4522 |
Adult size brief/diaper med |
1,619 |
1,479 |
$99K |
| A4927 |
Non-sterile gloves |
5,315 |
4,436 |
$80K |
| B4154 |
Ef spec metabolic noninherit |
828 |
570 |
$69K |
| T4525 |
Adult size pull-on sm |
1,230 |
1,120 |
$54K |
| T4540 |
Reusable underpad chair size |
1,275 |
1,167 |
$45K |
| B4102 |
Ef adult fluids and electro |
723 |
589 |
$43K |
| S0215 |
Nonemerg transp mileage |
368 |
350 |
$36K |
| T4543 |
Adult disp brief/diap abv xl |
109 |
95 |
$13K |
| T4524 |
Adult size brief/diaper xl |
173 |
161 |
$13K |
| A9150 |
Misc/exper non-prescript dru |
389 |
285 |
$3K |
| A6250 |
Skin seal protect moisturizr |
56 |
47 |
$2K |
| T4534 |
Youth size pull-on |
14 |
12 |
$1K |
| T4542 |
Small disposable underpad |
98 |
94 |
$1K |
| A4245 |
Alcohol wipes per box |
446 |
429 |
$1K |
| E0325 |
Urinal male jug-type |
458 |
454 |
$1K |
| B4100 |
Food thickener oral |
23 |
21 |
$1K |
| T4521 |
Adult size brief/diaper sm |
17 |
17 |
$757.52 |
| A4357 |
Bedside drainage bag |
14 |
12 |
$180.94 |
| A6402 |
Sterile gauze <= 16 sq in |
14 |
13 |
$123.76 |
| A6216 |
Non-sterile gauze<=16 sq in |
14 |
13 |
$114.00 |