| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult size pull-on xl |
1,921 |
1,779 |
$381K |
| T4535 |
Disposable liner/shield/pad |
3,131 |
2,911 |
$343K |
| T4527 |
Adult size pull-on lg |
1,920 |
1,814 |
$337K |
| T4526 |
Adult size pull-on med |
1,727 |
1,600 |
$257K |
| T4534 |
Youth size pull-on |
1,349 |
1,155 |
$255K |
| E1390 |
Oxygen concentrator |
6,891 |
6,241 |
$238K |
| S9999 |
Sales tax |
14,648 |
12,866 |
$134K |
| A7030 |
Cpap full face mask |
1,850 |
1,798 |
$133K |
| E0601 |
Cont airway pressure device |
3,379 |
3,278 |
$127K |
| A4927 |
Non-sterile gloves |
3,502 |
3,376 |
$99K |
| E0570 |
Nebulizer with compression |
4,347 |
4,094 |
$99K |
| E0260 |
Hosp bed semi-electr w/ matt |
2,818 |
2,684 |
$97K |
| T4541 |
Large disposable underpad |
1,517 |
1,469 |
$90K |
| A7031 |
Replacement facemask interfa |
2,538 |
2,465 |
$86K |
| A4604 |
Tubing with heating element |
2,860 |
2,800 |
$82K |
| A4385 |
Ost skn barrier sld ext wear |
1,173 |
1,097 |
$66K |
| A7034 |
Nasal application device |
1,005 |
990 |
$57K |
| T4542 |
Small disposable underpad |
1,176 |
1,145 |
$44K |
| K0001 |
Standard wheelchair |
1,958 |
1,865 |
$28K |
| A7032 |
Replacement nasal cushion |
691 |
675 |
$27K |
| A7035 |
Pos airway press headgear |
1,938 |
1,878 |
$27K |
| E0431 |
Portable gaseous 02 |
3,266 |
3,002 |
$22K |
| A7038 |
Pos airway pressure filter |
4,641 |
4,500 |
$21K |
| E0562 |
Humidifier heated used w pap |
1,610 |
1,580 |
$21K |
| A4351 |
Straight tip urine catheter |
161 |
153 |
$19K |
| T4522 |
Adult size brief/diaper med |
108 |
97 |
$15K |
| E1161 |
Manual adult wc w tiltinspac |
37 |
26 |
$14K |
| T4523 |
Adult size brief/diaper lg |
82 |
77 |
$14K |
| A7003 |
Nebulizer administration set |
3,724 |
3,537 |
$10K |
| A5063 |
Drain ostomy pouch w/flange |
491 |
451 |
$10K |
| A7046 |
Repl water chamber, pap dev |
978 |
964 |
$9K |
| A6530 |
Compression stocking bk18-30 |
153 |
139 |
$8K |
| E0143 |
Walker folding wheeled w/o s |
265 |
261 |
$8K |
| A4452 |
Waterproof tape |
262 |
235 |
$7K |
| T4524 |
Adult size brief/diaper xl |
27 |
27 |
$6K |
| T4537 |
Reusable underpad bed size |
375 |
363 |
$6K |
| A4409 |
Ost skn barr convex <=4 sq i |
84 |
78 |
$4K |
| A5120 |
Skin barrier, wipe or swab |
958 |
860 |
$4K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
29 |
27 |
$3K |
| A7033 |
Replacement nasal pillows |
104 |
103 |
$3K |
| B4035 |
Enteral feed supp pump per d |
94 |
38 |
$3K |
| A7015 |
Aerosol mask used w nebulize |
1,655 |
1,573 |
$2K |
| T4525 |
Adult size pull-on sm |
13 |
12 |
$2K |
| A6402 |
Sterile gauze <= 16 sq in |
162 |
134 |
$2K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
27 |
26 |
$1K |
| A7039 |
Filter, non disposable w pap |
144 |
141 |
$699.20 |
| A4407 |
Ext wear ost skn barr <=4sq" |
18 |
13 |
$653.12 |
| K0823 |
Pwc gp 2 std cap chair |
13 |
12 |
$619.95 |
| A4357 |
Bedside drainage bag |
209 |
197 |
$562.86 |
| A4425 |
Ost pch drain for barrier fl |
32 |
25 |
$559.86 |
| A7037 |
Pos airway pressure tubing |
67 |
65 |
$540.90 |
| E0973 |
W/ch access det adj armrest |
22 |
12 |
$538.40 |
| A6446 |
Conform band s w>=3" <5"/yd |
12 |
12 |
$516.61 |
| A6216 |
Non-sterile gauze<=16 sq in |
30 |
26 |
$192.48 |
| A4456 |
Adhesive remover, wipes |
12 |
12 |
$62.68 |
| A4371 |
Skin barrier powder per oz |
25 |
24 |
$34.26 |