| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
13,130 |
12,101 |
$791K |
| A4927 |
Non-sterile gloves |
12,265 |
11,449 |
$477K |
| T4527 |
Adult size pull-on lg |
3,364 |
3,144 |
$475K |
| E1390 |
Oxygen concentrator |
8,353 |
6,242 |
$450K |
| T4528 |
Adult size pull-on xl |
3,197 |
2,978 |
$449K |
| T4526 |
Adult size pull-on med |
2,723 |
2,560 |
$347K |
| T4544 |
Adlt disp und/pull on abv xl |
1,511 |
1,361 |
$282K |
| E0601 |
Cont airway pressure device |
6,898 |
4,852 |
$236K |
| T4522 |
Adult size brief/diaper med |
1,501 |
1,388 |
$191K |
| B4150 |
Ef complet w/intact nutrient |
2,255 |
1,460 |
$130K |
| T4523 |
Adult size brief/diaper lg |
771 |
721 |
$105K |
| E0260 |
Hosp bed semi-electr w/ matt |
4,455 |
2,804 |
$98K |
| K0738 |
Portable gas oxygen system |
6,609 |
4,958 |
$96K |
| A7030 |
Cpap full face mask |
1,396 |
1,188 |
$94K |
| B4154 |
Ef spec metabolic noninherit |
1,103 |
571 |
$80K |
| K0001 |
Standard wheelchair |
4,667 |
3,093 |
$59K |
| T4543 |
Adult disp brief/diap abv xl |
267 |
254 |
$53K |
| B4152 |
Ef calorie dense>/=1.5kcal |
586 |
361 |
$49K |
| E0562 |
Humidifier heated used w pap |
308 |
260 |
$34K |
| E0570 |
Nebulizer with compression |
3,632 |
2,436 |
$33K |
| E0143 |
Walker folding wheeled w/o s |
921 |
760 |
$30K |
| T4524 |
Adult size brief/diaper xl |
199 |
178 |
$27K |
| A7037 |
Pos airway pressure tubing |
2,100 |
1,756 |
$26K |
| T4535 |
Disposable liner/shield/pad |
2,028 |
899 |
$26K |
| A7035 |
Pos airway press headgear |
1,589 |
1,326 |
$22K |
| T4525 |
Adult size pull-on sm |
106 |
99 |
$13K |
| E0630 |
Patient lift hydraulic |
387 |
267 |
$10K |
| E0156 |
Walker seat attachment |
1,262 |
1,019 |
$7K |
| E0434 |
Portable liquid 02 |
292 |
238 |
$3K |
| K0195 |
Elevating whlchair leg rests |
948 |
647 |
$2K |
| A7034 |
Nasal application device |
41 |
38 |
$2K |
| A7003 |
Nebulizer administration set |
814 |
699 |
$1K |
| B4034 |
Enter feed supkit syr by day |
23 |
12 |
$1K |
| E0149 |
Heavy duty wheeled walker |
13 |
12 |
$862.28 |
| A7015 |
Aerosol mask used w nebulize |
693 |
585 |
$829.61 |
| A7039 |
Filter, non disposable w pap |
189 |
156 |
$772.74 |
| A7013 |
Disposable compressor filter |
579 |
501 |
$260.87 |
| A4335 |
Incontinence supply |
31 |
31 |
$244.20 |
| A7038 |
Pos airway pressure filter |
14 |
14 |
$71.22 |
| E0444 |
Portable 02 contents, liquid |
12 |
12 |
$0.00 |