| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| X1939 |
|
1,965 |
1,961 |
$130K |
| A4554 |
Disposable underpads, all sizes |
2,506 |
2,401 |
$79K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,165 |
1,154 |
$53K |
| T5999 |
Supply, not otherwise specified |
6,059 |
5,434 |
$41K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,295 |
1,154 |
$37K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
456 |
398 |
$26K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
192 |
163 |
$9K |
| K0001 |
Standard wheelchair |
323 |
272 |
$8K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
64 |
53 |
$3K |
| E0570 |
Nebulizer, with compressor |
122 |
115 |
$2K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
27 |
24 |
$376.66 |