| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
1,037 |
946 |
$112K |
| E1390 |
Oxygen concentrator |
3,826 |
2,983 |
$93K |
| T4542 |
Small disposable underpad |
2,415 |
2,131 |
$87K |
| T4535 |
Disposable liner/shield/pad |
1,165 |
1,051 |
$63K |
| T4528 |
Adult size pull-on xl |
154 |
145 |
$19K |
| E0431 |
Portable gaseous 02 |
2,594 |
1,923 |
$18K |
| E0601 |
Cont airway pressure device |
466 |
362 |
$12K |
| A4927 |
Non-sterile gloves |
803 |
665 |
$11K |
| K0001 |
Standard wheelchair |
788 |
635 |
$9K |
| E0570 |
Nebulizer with compression |
2,072 |
1,640 |
$7K |
| T4526 |
Adult size pull-on med |
63 |
52 |
$5K |
| E0562 |
Humidifier heated used w pap |
535 |
360 |
$4K |
| E0260 |
Hosp bed semi-electr w/ matt |
279 |
235 |
$4K |
| E0470 |
Rad w/o backup non-inv intfc |
18 |
12 |
$2K |
| E0971 |
Wheelchair anti-tipping devi |
1,304 |
519 |
$1K |
| A7038 |
Pos airway pressure filter |
288 |
211 |
$430.00 |
| A4604 |
Tubing with heating element |
72 |
50 |
$280.91 |
| E0143 |
Walker folding wheeled w/o s |
38 |
31 |
$232.19 |
| A7035 |
Pos airway press headgear |
40 |
25 |
$150.05 |