| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1999 |
Noc retail items andsupplies |
6,266 |
5,553 |
$262K |
| E1390 |
Oxygen concentrator |
3,368 |
2,894 |
$224K |
| T4535 |
Disposable liner/shield/pad |
2,967 |
2,615 |
$162K |
| T4541 |
Large disposable underpad |
3,412 |
3,041 |
$134K |
| T4527 |
Adult size pull-on lg |
940 |
835 |
$128K |
| T4534 |
Youth size pull-on |
987 |
852 |
$113K |
| T4526 |
Adult size pull-on med |
1,010 |
908 |
$112K |
| E0466 |
Home vent non-invasive inter |
227 |
216 |
$108K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
533 |
419 |
$98K |
| A4927 |
Non-sterile gloves |
3,325 |
2,775 |
$71K |
| A9999 |
Dme supply or accessory, nos |
2,177 |
1,480 |
$67K |
| E1392 |
Portable oxygen concentrator |
1,949 |
1,699 |
$44K |
| T4537 |
Reusable underpad bed size |
1,309 |
1,142 |
$43K |
| T4522 |
Adult size brief/diaper med |
311 |
307 |
$38K |
| E0601 |
Cont airway pressure device |
643 |
566 |
$31K |
| A6250 |
Skin seal protect moisturizr |
4,524 |
2,747 |
$28K |
| T4528 |
Adult size pull-on xl |
244 |
185 |
$27K |
| K0001 |
Standard wheelchair |
697 |
662 |
$17K |
| A4604 |
Tubing with heating element |
486 |
394 |
$17K |
| E0570 |
Nebulizer with compression |
904 |
831 |
$13K |
| A7031 |
Replacement facemask interfa |
381 |
305 |
$13K |
| A7030 |
Cpap full face mask |
136 |
110 |
$11K |
| B4035 |
Enteral feed supp pump per d |
41 |
36 |
$8K |
| B4161 |
Ef ped hydrolyzed/amino acid |
17 |
12 |
$6K |
| K0738 |
Portable gas oxygen system |
266 |
245 |
$5K |
| E0260 |
Hosp bed semi-electr w/ matt |
28 |
27 |
$5K |
| A7035 |
Pos airway press headgear |
223 |
173 |
$4K |
| A7038 |
Pos airway pressure filter |
1,027 |
853 |
$4K |
| A7034 |
Nasal application device |
41 |
37 |
$3K |
| E0562 |
Humidifier heated used w pap |
95 |
91 |
$2K |
| E0971 |
Wheelchair anti-tipping devi |
772 |
430 |
$2K |
| A7032 |
Replacement nasal cushion |
45 |
40 |
$1K |
| A7039 |
Filter, non disposable w pap |
150 |
120 |
$967.88 |
| A7046 |
Repl water chamber, pap dev |
18 |
16 |
$150.78 |