| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
1,405 |
785 |
$119K |
| T4527 |
Adult size pull-on lg |
799 |
707 |
$87K |
| A4554 |
Disposable underpads |
2,960 |
2,708 |
$87K |
| E1390 |
Oxygen concentrator |
910 |
793 |
$80K |
| K0001 |
Standard wheelchair |
1,019 |
942 |
$72K |
| T4528 |
Adult size pull-on xl |
410 |
368 |
$59K |
| E0601 |
Cont airway pressure device |
377 |
332 |
$48K |
| A4351 |
Straight tip urine catheter |
315 |
280 |
$45K |
| E0143 |
Walker folding wheeled w/o s |
733 |
670 |
$32K |
| T4526 |
Adult size pull-on med |
284 |
274 |
$30K |
| A5061 |
Pouch drainable w barrier at |
518 |
457 |
$28K |
| A6446 |
Conform band s w>=3" <5"/yd |
825 |
750 |
$25K |
| A4452 |
Waterproof tape |
1,082 |
986 |
$23K |
| E0431 |
Portable gaseous 02 |
1,047 |
879 |
$19K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
216 |
208 |
$18K |
| A4335 |
Incontinence supply |
3,831 |
3,406 |
$11K |
| A6216 |
Non-sterile gauze<=16 sq in |
1,508 |
1,320 |
$10K |
| T4535 |
Disposable liner/shield/pad |
262 |
255 |
$9K |
| E0570 |
Nebulizer with compression |
209 |
190 |
$8K |
| A4385 |
Ost skn barrier sld ext wear |
95 |
90 |
$8K |
| A4927 |
Non-sterile gloves |
1,307 |
1,146 |
$8K |
| A4406 |
Pectin based ostomy paste |
496 |
447 |
$7K |
| A5120 |
Skin barrier, wipe or swab |
1,019 |
944 |
$5K |
| A6258 |
Transparent film >16<=48 in |
116 |
104 |
$5K |
| B4150 |
Ef complet w/intact nutrient |
15 |
14 |
$5K |
| K0195 |
Elevating whlchair leg rests |
153 |
150 |
$5K |
| B4034 |
Enter feed supkit syr by day |
91 |
81 |
$4K |
| A4217 |
Sterile water/saline, 500 ml |
653 |
540 |
$3K |
| E0260 |
Hosp bed semi-electr w/ matt |
12 |
12 |
$2K |
| A7031 |
Replacement facemask interfa |
63 |
63 |
$2K |
| A6450 |
Lt compres band >=5"/yd |
82 |
74 |
$2K |
| A7035 |
Pos airway press headgear |
101 |
90 |
$2K |
| A6402 |
Sterile gauze <= 16 sq in |
230 |
174 |
$2K |
| A6212 |
Foam drg <=16 sq in w/border |
15 |
13 |
$2K |
| A4456 |
Adhesive remover, wipes |
300 |
289 |
$1K |
| A7030 |
Cpap full face mask |
17 |
14 |
$1K |
| A7037 |
Pos airway pressure tubing |
78 |
69 |
$1K |
| T4525 |
Adult size pull-on sm |
12 |
12 |
$1K |
| A7038 |
Pos airway pressure filter |
200 |
184 |
$996.69 |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
26 |
25 |
$902.19 |
| E0240 |
Bath/shower chair |
13 |
12 |
$877.18 |
| A4402 |
Lubricant per ounce |
207 |
198 |
$801.22 |
| A4371 |
Skin barrier powder per oz |
234 |
227 |
$774.66 |
| A4216 |
Sterile water/saline, 10 ml |
65 |
61 |
$774.36 |
| E0163 |
Commode chair with fixed arm |
13 |
13 |
$721.53 |
| A5112 |
Urinary leg bag |
29 |
26 |
$678.88 |
| E0135 |
Walker folding adjust/fixed |
16 |
16 |
$581.45 |
| E0155 |
Walker wheel attachment,pair |
29 |
28 |
$194.43 |
| A4245 |
Alcohol wipes per box |
103 |
83 |
$124.15 |
| A7003 |
Nebulizer administration set |
35 |
24 |
$49.89 |
| A7013 |
Disposable compressor filter |
35 |
24 |
$17.93 |
| A7015 |
Aerosol mask used w nebulize |
18 |
12 |
$15.17 |
| E0156 |
Walker seat attachment |
25 |
25 |
$0.00 |