| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/pad |
5,364 |
5,253 |
$289K |
| E1390 |
Oxygen concentrator |
4,928 |
4,924 |
$283K |
| T4527 |
Adult size pull-on lg |
2,118 |
2,099 |
$194K |
| T4526 |
Adult size pull-on med |
1,891 |
1,870 |
$177K |
| E0570 |
Nebulizer with compression |
3,611 |
3,610 |
$171K |
| T4541 |
Large disposable underpad |
3,512 |
3,465 |
$121K |
| T4528 |
Adult size pull-on xl |
1,006 |
995 |
$110K |
| E1392 |
Portable oxygen concentrator |
3,773 |
3,771 |
$63K |
| E0601 |
Cont airway pressure device |
1,356 |
1,356 |
$59K |
| K0001 |
Standard wheelchair |
2,244 |
2,243 |
$58K |
| A7030 |
Cpap full face mask |
687 |
687 |
$52K |
| T4523 |
Adult size brief/diaper lg |
102 |
102 |
$20K |
| A4927 |
Non-sterile gloves |
537 |
519 |
$20K |
| A7037 |
Pos airway pressure tubing |
1,191 |
1,191 |
$16K |
| T1999 |
Noc retail items andsupplies |
68 |
66 |
$15K |
| T4543 |
Adult disp brief/diap abv xl |
78 |
76 |
$13K |
| E0562 |
Humidifier heated used w pap |
781 |
780 |
$13K |
| A7035 |
Pos airway press headgear |
666 |
665 |
$12K |
| E0260 |
Hosp bed semi-electr w/ matt |
432 |
432 |
$10K |
| A7038 |
Pos airway pressure filter |
2,042 |
2,037 |
$7K |
| T4537 |
Reusable underpad bed size |
82 |
82 |
$6K |
| A7031 |
Replacement facemask interfa |
707 |
706 |
$5K |
| A4335 |
Incontinence supply |
439 |
431 |
$4K |
| A7005 |
Nondisposable nebulizer set |
87 |
87 |
$2K |
| A4253 |
Blood glucose/reagent strips |
653 |
613 |
$1K |
| Q0513 |
Disp fee inhal drugs/30 days |
221 |
219 |
$1K |
| E0143 |
Walker folding wheeled w/o s |
14 |
14 |
$577.17 |
| A7003 |
Nebulizer administration set |
163 |
163 |
$466.93 |
| A7046 |
Repl water chamber, pap dev |
27 |
27 |
$222.85 |
| A7015 |
Aerosol mask used w nebulize |
12 |
12 |
$16.68 |
| A4259 |
Lancets per box |
86 |
82 |
$16.61 |