| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
36,726 |
36,422 |
$1.33M |
| T4527 |
Adult size pull-on lg |
9,980 |
9,915 |
$1.19M |
| T4535 |
Disposable liner/shield/pad |
25,019 |
23,966 |
$1.09M |
| T4526 |
Adult size pull-on med |
7,392 |
7,340 |
$800K |
| T4528 |
Adult size pull-on xl |
4,739 |
4,704 |
$692K |
| A4335 |
Incontinence supply |
41,049 |
40,232 |
$222K |
| E0570 |
Nebulizer with compression |
2,678 |
2,654 |
$200K |
| T4523 |
Adult size brief/diaper lg |
679 |
675 |
$74K |
| A4253 |
Blood glucose/reagent strips |
2,738 |
2,382 |
$54K |
| T4544 |
Adlt disp und/pull on abv xl |
173 |
165 |
$38K |
| T4534 |
Youth size pull-on |
322 |
320 |
$37K |
| A4670 |
Automatic bp monitor, dial |
613 |
603 |
$36K |
| T4532 |
Ped size pull-on lg |
142 |
142 |
$21K |
| T4525 |
Adult size pull-on sm |
187 |
186 |
$17K |
| T4524 |
Adult size brief/diaper xl |
91 |
90 |
$14K |
| A4259 |
Lancets per box |
2,154 |
2,077 |
$10K |
| A7003 |
Nebulizer administration set |
2,431 |
2,396 |
$4K |
| A7015 |
Aerosol mask used w nebulize |
2,443 |
2,403 |
$3K |
| K0003 |
Lightweight wheelchair |
199 |
191 |
$2K |
| A4245 |
Alcohol wipes per box |
1,292 |
1,254 |
$2K |
| E0240 |
Bath/shower chair |
13 |
13 |
$1K |
| K0001 |
Standard wheelchair |
89 |
88 |
$371.62 |
| A5512 |
Multi den insert direct form |
12 |
12 |
$0.00 |
| A5500 |
Diab shoe for density insert |
12 |
12 |
$0.00 |