| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1161 |
Manual adult wc w tiltinspac |
732 |
610 |
$265K |
| E1390 |
Oxygen concentrator |
6,941 |
6,062 |
$225K |
| E1028 |
W/c manual swingaway |
2,116 |
1,248 |
$218K |
| A4554 |
Disposable underpads |
2,523 |
2,343 |
$171K |
| T4523 |
Adult size brief/diaper lg |
1,397 |
1,273 |
$119K |
| A4927 |
Non-sterile gloves |
3,295 |
2,943 |
$113K |
| E0601 |
Cont airway pressure device |
5,124 |
4,226 |
$110K |
| T4522 |
Adult size brief/diaper med |
1,411 |
1,300 |
$108K |
| E0431 |
Portable gaseous 02 |
4,166 |
3,605 |
$77K |
| A7030 |
Cpap full face mask |
1,769 |
1,522 |
$52K |
| E0562 |
Humidifier heated used w pap |
1,671 |
1,397 |
$40K |
| E0955 |
Cushioned headrest |
989 |
860 |
$34K |
| K0108 |
W/c component-accessory nos |
137 |
61 |
$25K |
| E0570 |
Nebulizer with compression |
964 |
877 |
$18K |
| A7034 |
Nasal application device |
714 |
623 |
$17K |
| E0470 |
Rad w/o backup non-inv intfc |
297 |
243 |
$16K |
| E2311 |
Electro connect btw 2 sys |
14 |
12 |
$14K |
| A4351 |
Straight tip urine catheter |
196 |
173 |
$13K |
| E0973 |
W/ch access det adj armrest |
211 |
135 |
$12K |
| A7035 |
Pos airway press headgear |
2,030 |
1,776 |
$11K |
| A4604 |
Tubing with heating element |
1,691 |
1,415 |
$11K |
| A7031 |
Replacement facemask interfa |
1,350 |
1,145 |
$10K |
| K0040 |
Adjustable angle footplate |
288 |
161 |
$9K |
| T2029 |
Special med equip, noswaiver |
308 |
274 |
$8K |
| A7038 |
Pos airway pressure filter |
2,831 |
2,361 |
$8K |
| A7037 |
Pos airway pressure tubing |
645 |
588 |
$6K |
| T4524 |
Adult size brief/diaper xl |
87 |
73 |
$5K |
| K0001 |
Standard wheelchair |
623 |
515 |
$4K |
| E0971 |
Wheelchair anti-tipping devi |
101 |
66 |
$4K |
| E2607 |
Skin pro/pos wc cus wd <22in |
25 |
25 |
$4K |
| K0739 |
Repair/svc dme non-oxygen eq |
86 |
73 |
$972.37 |
| A7032 |
Replacement nasal cushion |
111 |
89 |
$877.95 |
| E0951 |
Loop heel |
28 |
14 |
$273.92 |
| A7046 |
Repl water chamber, pap dev |
94 |
79 |
$268.55 |
| E2211 |
Pneumatic propulsion tire |
18 |
14 |
$262.08 |
| E0978 |
W/c acc,saf belt pelv strap |
14 |
12 |
$61.31 |
| A7039 |
Filter, non disposable w pap |
80 |
65 |
$2.86 |
| E2620 |
Wc planar back cush wd <22in |
12 |
12 |
$0.00 |