| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult size pull-on xl |
4,867 |
4,591 |
$531K |
| B4150 |
Ef complet w/intact nutrient |
2,214 |
2,047 |
$320K |
| T4543 |
Adult disp brief/diap abv xl |
900 |
841 |
$224K |
| T4541 |
Large disposable underpad |
3,375 |
3,198 |
$133K |
| T4527 |
Adult size pull-on lg |
814 |
711 |
$67K |
| E0570 |
Nebulizer with compression |
828 |
797 |
$25K |
| E0730 |
Tens four lead |
517 |
504 |
$23K |
| A4927 |
Non-sterile gloves |
1,552 |
1,453 |
$22K |
| T4526 |
Adult size pull-on med |
249 |
220 |
$21K |
| T4524 |
Adult size brief/diaper xl |
131 |
124 |
$13K |
| B4152 |
Ef calorie dense>/=1.5kcal |
43 |
38 |
$6K |
| A4253 |
Blood glucose/reagent strips |
1,086 |
995 |
$4K |
| A5500 |
Diab shoe for density insert |
146 |
82 |
$4K |
| A4670 |
Automatic bp monitor, dial |
75 |
74 |
$3K |
| T4521 |
Adult size brief/diaper sm |
40 |
38 |
$3K |
| T4523 |
Adult size brief/diaper lg |
29 |
25 |
$3K |
| A6530 |
Compression stocking bk18-30 |
32 |
25 |
$2K |
| A5513 |
Multi den insert custom mold |
44 |
25 |
$1K |
| A5514 |
Mult den insert dir carv/cam |
24 |
12 |
$488.40 |
| Q0513 |
Disp fee inhal drugs/30 days |
14 |
13 |
$118.80 |
| A7003 |
Nebulizer administration set |
41 |
40 |
$106.63 |
| A4259 |
Lancets per box |
31 |
27 |
$17.82 |