| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
11,094 |
10,944 |
$779K |
| T4527 |
Adult size pull-on lg |
1,268 |
1,261 |
$138K |
| T4526 |
Adult size pull-on med |
1,338 |
1,336 |
$123K |
| E0431 |
Portable gaseous 02 |
8,569 |
8,471 |
$119K |
| A4554 |
Disposable underpads |
3,956 |
3,943 |
$95K |
| E0570 |
Nebulizer with compression |
1,479 |
1,459 |
$85K |
| A7030 |
Cpap full face mask |
1,325 |
1,306 |
$71K |
| A7031 |
Replacement facemask interfa |
2,027 |
1,983 |
$65K |
| E0601 |
Cont airway pressure device |
2,238 |
2,211 |
$65K |
| K0001 |
Standard wheelchair |
2,207 |
2,185 |
$42K |
| T4535 |
Disposable liner/shield/pad |
1,245 |
1,196 |
$36K |
| E0260 |
Hosp bed semi-electr w/ matt |
682 |
677 |
$32K |
| B9998 |
Enteral supp not otherwise c |
355 |
319 |
$32K |
| T4528 |
Adult size pull-on xl |
268 |
268 |
$31K |
| A4335 |
Incontinence supply |
4,662 |
4,639 |
$25K |
| A7038 |
Pos airway pressure filter |
3,172 |
3,076 |
$15K |
| T4522 |
Adult size brief/diaper med |
194 |
191 |
$14K |
| K0002 |
Stnd hemi (low seat) whlchr |
881 |
875 |
$12K |
| A7000 |
Disposable canister for pump |
520 |
500 |
$12K |
| A7035 |
Pos airway press headgear |
1,052 |
1,031 |
$11K |
| A7037 |
Pos airway pressure tubing |
772 |
747 |
$9K |
| A7034 |
Nasal application device |
224 |
220 |
$7K |
| A7002 |
Tubing used w suction pump |
441 |
423 |
$6K |
| A7003 |
Nebulizer administration set |
1,393 |
1,367 |
$5K |
| A7032 |
Replacement nasal cushion |
129 |
126 |
$5K |
| E0143 |
Walker folding wheeled w/o s |
125 |
122 |
$4K |
| K0195 |
Elevating whlchair leg rests |
614 |
603 |
$3K |
| A7046 |
Repl water chamber, pap dev |
416 |
403 |
$2K |
| E0163 |
Commode chair with fixed arm |
68 |
65 |
$2K |
| A4604 |
Tubing with heating element |
811 |
808 |
$2K |
| K0738 |
Portable gas oxygen system |
414 |
413 |
$2K |
| A4628 |
Oropharyngeal suction cath |
303 |
290 |
$1K |
| K0003 |
Lightweight wheelchair |
195 |
195 |
$1K |
| A7015 |
Aerosol mask used w nebulize |
906 |
887 |
$1K |
| E1392 |
Portable oxygen concentrator |
494 |
485 |
$917.47 |
| A7033 |
Replacement nasal pillows |
24 |
24 |
$789.02 |
| L3660 |
So 8 ab rstr can/web pre ots |
12 |
12 |
$600.27 |
| E0114 |
Crutch underarm pair no wood |
26 |
26 |
$549.20 |
| E0443 |
Portable 02 contents, gas |
151 |
151 |
$518.51 |
| A7526 |
Tracheostomy tube collar |
24 |
24 |
$444.37 |
| A4322 |
Irrigation syringe |
51 |
49 |
$269.68 |
| E0971 |
Wheelchair anti-tipping devi |
25 |
13 |
$210.17 |
| T1999 |
Noc retail items andsupplies |
12 |
12 |
$72.51 |