| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
3,994 |
2,544 |
$157K |
| E1390 |
Oxygen concentrator |
7,928 |
3,555 |
$144K |
| T4527 |
Adult size pull-on lg |
1,267 |
741 |
$123K |
| E0570 |
Nebulizer with compression |
5,004 |
2,887 |
$98K |
| T4528 |
Adult size pull-on xl |
764 |
535 |
$91K |
| A4409 |
Ost skn barr convex <=4 sq i |
2,008 |
906 |
$82K |
| K0823 |
Pwc gp 2 std cap chair |
668 |
375 |
$76K |
| A4385 |
Ost skn barrier sld ext wear |
1,462 |
703 |
$56K |
| E0260 |
Hosp bed semi-electr w/ matt |
4,540 |
2,138 |
$51K |
| T4526 |
Adult size pull-on med |
506 |
302 |
$45K |
| A4362 |
Solid skin barrier |
1,542 |
697 |
$34K |
| K0001 |
Standard wheelchair |
7,027 |
3,711 |
$32K |
| E0601 |
Cont airway pressure device |
1,146 |
646 |
$31K |
| A4351 |
Straight tip urine catheter |
469 |
215 |
$27K |
| A5063 |
Drain ostomy pouch w/flange |
909 |
516 |
$18K |
| A4425 |
Ost pch drain for barrier fl |
983 |
456 |
$17K |
| E0431 |
Portable gaseous 02 |
5,230 |
2,567 |
$15K |
| A4394 |
Ostomy pouch liq deodorant |
1,093 |
636 |
$14K |
| A5120 |
Skin barrier, wipe or swab |
4,358 |
2,120 |
$12K |
| A4406 |
Pectin based ostomy paste |
1,685 |
836 |
$12K |
| A4456 |
Adhesive remover, wipes |
2,990 |
1,506 |
$10K |
| A4432 |
Os pch urine w bar/fange/tap |
438 |
235 |
$9K |
| A4371 |
Skin barrier powder per oz |
1,590 |
859 |
$8K |
| A4407 |
Ext wear ost skn barr <=4sq" |
124 |
80 |
$8K |
| B4035 |
Enteral feed supp pump per d |
491 |
171 |
$7K |
| E0143 |
Walker folding wheeled w/o s |
424 |
237 |
$7K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
313 |
151 |
$6K |
| A4520 |
Incontinence garment anytype |
609 |
392 |
$6K |
| A5056 |
1 pc ost pouch w filter |
178 |
100 |
$6K |
| A4357 |
Bedside drainage bag |
1,683 |
726 |
$5K |
| B4152 |
Ef calorie dense>/=1.5kcal |
105 |
63 |
$4K |
| B4154 |
Ef spec metabolic noninherit |
123 |
52 |
$3K |
| B9002 |
Enter nutr inf pump any type |
256 |
105 |
$2K |
| A7037 |
Pos airway pressure tubing |
56 |
40 |
$889.93 |
| E0255 |
Hospital bed var ht w/ mattr |
276 |
179 |
$864.33 |
| A7003 |
Nebulizer administration set |
421 |
328 |
$736.80 |
| A4627 |
Spacer bag/reservoir |
62 |
24 |
$601.63 |
| A4367 |
Ostomy belt |
153 |
105 |
$492.77 |
| A7038 |
Pos airway pressure filter |
66 |
48 |
$211.84 |
| A7013 |
Disposable compressor filter |
585 |
389 |
$179.12 |
| K0195 |
Elevating whlchair leg rests |
100 |
73 |
$178.74 |
| A4369 |
Skin barrier liquid per oz |
47 |
26 |
$148.33 |
| E0776 |
Iv pole |
42 |
24 |
$130.61 |
| E0156 |
Walker seat attachment |
20 |
14 |
$61.79 |