| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
9,210 |
8,508 |
$296K |
| X1939 |
|
3,639 |
3,612 |
$227K |
| T4528 |
Adult size pull-on xl |
2,010 |
1,965 |
$133K |
| T5999 |
Supply, nos |
15,465 |
13,872 |
$126K |
| T4527 |
Adult size pull-on lg |
2,206 |
2,123 |
$118K |
| T4526 |
Adult size pull-on med |
2,260 |
2,173 |
$103K |
| T4535 |
Disposable liner/shield/pad |
2,625 |
2,565 |
$77K |
| K0003 |
Lightweight wheelchair |
4,140 |
2,530 |
$65K |
| T4534 |
Youth size pull-on |
771 |
718 |
$64K |
| E0570 |
Nebulizer with compression |
1,356 |
947 |
$43K |
| T4525 |
Adult size pull-on sm |
570 |
542 |
$37K |
| E0601 |
Cont airway pressure device |
1,151 |
907 |
$36K |
| E1390 |
Oxygen concentrator |
831 |
622 |
$30K |
| A4927 |
Non-sterile gloves |
2,426 |
1,628 |
$26K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,127 |
588 |
$20K |
| T4543 |
Adult disp brief/diap abv xl |
144 |
129 |
$18K |
| K0001 |
Standard wheelchair |
1,310 |
1,112 |
$17K |
| T4524 |
Adult size brief/diaper xl |
61 |
59 |
$8K |
| A7005 |
Nondisposable nebulizer set |
321 |
279 |
$6K |
| T4523 |
Adult size brief/diaper lg |
61 |
52 |
$5K |
| K0195 |
Elevating whlchair leg rests |
994 |
662 |
$3K |
| E0431 |
Portable gaseous 02 |
419 |
338 |
$3K |
| E0562 |
Humidifier heated used w pap |
149 |
92 |
$3K |
| T4522 |
Adult size brief/diaper med |
32 |
31 |
$2K |
| E0973 |
W/ch access det adj armrest |
34 |
27 |
$1K |
| T2028 |
Special supply, nos waiver |
19 |
12 |
$1K |
| A7014 |
Compressor nondispos filter |
301 |
261 |
$932.89 |
| E0971 |
Wheelchair anti-tipping devi |
35 |
26 |
$759.44 |
| A7015 |
Aerosol mask used w nebulize |
351 |
308 |
$469.76 |
| E0165 |
Commode chair with detacharm |
69 |
38 |
$452.53 |
| E0978 |
W/c acc,saf belt pelv strap |
30 |
26 |
$313.74 |
| E0961 |
Wheelchair brake extension |
16 |
12 |
$258.58 |
| E0951 |
Loop heel |
30 |
24 |
$242.02 |
| E2601 |
Gen w/c cushion wdth < 22 in |
15 |
13 |
$201.53 |
| A7038 |
Pos airway pressure filter |
13 |
13 |
$19.63 |