| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
1,386 |
1,386 |
$87K |
| A4335 |
Incontinence supply; miscellaneous |
1,001 |
988 |
$54K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
773 |
765 |
$42K |
| E0601 |
Continuous positive airway pressure (cpap) device |
657 |
657 |
$33K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
285 |
283 |
$28K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
218 |
215 |
$26K |
| T4541 |
Incontinence product, disposable underpad, large, each |
693 |
684 |
$26K |
| A4927 |
Gloves, non-sterile, per 100 |
785 |
781 |
$23K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
483 |
483 |
$10K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
52 |
50 |
$6K |
| E1392 |
Portable oxygen concentrator, rental |
285 |
285 |
$5K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
12 |
12 |
$50.07 |