| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
2,036 |
2,016 |
$74K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
1,184 |
1,175 |
$47K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
183 |
180 |
$34K |
| A4335 |
Incontinence supply; miscellaneous |
2,573 |
2,505 |
$13K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
309 |
309 |
$7K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
952 |
944 |
$7K |
| K0003 |
Lightweight wheelchair |
160 |
160 |
$2K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
13 |
13 |
$2K |
| K0001 |
Standard wheelchair |
26 |
26 |
$278.35 |