| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4239 |
Non-adju cgm supply allow |
85 |
81 |
$21K |
| A4554 |
Disposable underpads |
196 |
178 |
$15K |
| A4670 |
Automatic bp monitor, dial |
305 |
304 |
$15K |
| T4522 |
Adult size brief/diaper med |
85 |
80 |
$10K |
| A4456 |
Adhesive remover, wipes |
185 |
170 |
$2K |
| E2103 |
Non-adju cgm receiver/mon |
22 |
19 |
$1K |
| A4927 |
Non-sterile gloves |
164 |
151 |
$694.60 |
| A7038 |
Pos airway pressure filter |
65 |
61 |
$241.98 |
| A7035 |
Pos airway press headgear |
19 |
16 |
$194.27 |
| E0601 |
Cont airway pressure device |
17 |
14 |
$126.64 |
| A7039 |
Filter, non disposable w pap |
18 |
15 |
$19.56 |
| A4604 |
Tubing with heating element |
14 |
12 |
$14.24 |