| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4351 |
Straight tip urine catheter |
1,571 |
1,505 |
$797K |
| T4541 |
Large disposable underpad |
10,631 |
10,600 |
$472K |
| T4523 |
Adult size brief/diaper lg |
2,563 |
2,555 |
$204K |
| E1399 |
Durable medical equipment mi |
299 |
216 |
$185K |
| T4527 |
Adult size pull-on lg |
2,348 |
2,333 |
$141K |
| T4526 |
Adult size pull-on med |
2,469 |
2,468 |
$127K |
| T4535 |
Disposable liner/shield/pad |
2,719 |
2,712 |
$106K |
| T4524 |
Adult size brief/diaper xl |
1,521 |
1,518 |
$101K |
| T4528 |
Adult size pull-on xl |
1,384 |
1,380 |
$90K |
| T4522 |
Adult size brief/diaper med |
1,214 |
1,214 |
$86K |
| E1390 |
Oxygen concentrator |
900 |
886 |
$76K |
| A6446 |
Conform band s w>=3" <5"/yd |
1,055 |
1,040 |
$64K |
| A4217 |
Sterile water/saline, 500 ml |
1,271 |
1,231 |
$63K |
| E0601 |
Cont airway pressure device |
753 |
744 |
$59K |
| A6216 |
Non-sterile gauze<=16 sq in |
2,943 |
2,883 |
$55K |
| A4670 |
Automatic bp monitor, dial |
451 |
449 |
$41K |
| E0562 |
Humidifier heated used w pap |
822 |
814 |
$40K |
| K0001 |
Standard wheelchair |
470 |
449 |
$37K |
| A7030 |
Cpap full face mask |
305 |
305 |
$29K |
| K0108 |
W/c component-accessory nos |
147 |
61 |
$26K |
| A4335 |
Incontinence supply |
1,260 |
1,257 |
$25K |
| E0570 |
Nebulizer with compression |
293 |
291 |
$25K |
| A6197 |
Alginate drsg >16 <=48 sq in |
57 |
57 |
$23K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
214 |
211 |
$21K |
| A4349 |
Disposable male external cat |
388 |
385 |
$21K |
| A7034 |
Nasal application device |
336 |
334 |
$19K |
| E0431 |
Portable gaseous 02 |
688 |
635 |
$19K |
| E0143 |
Walker folding wheeled w/o s |
407 |
403 |
$19K |
| A7039 |
Filter, non disposable w pap |
946 |
945 |
$16K |
| A4927 |
Non-sterile gloves |
1,235 |
1,228 |
$14K |
| T4525 |
Adult size pull-on sm |
381 |
380 |
$14K |
| A7037 |
Pos airway pressure tubing |
916 |
912 |
$13K |
| A7035 |
Pos airway press headgear |
869 |
867 |
$12K |
| A4357 |
Bedside drainage bag |
528 |
515 |
$11K |
| E0240 |
Bath/shower chair |
56 |
56 |
$11K |
| A6220 |
Gauze >16 <=48 sq in w/bordr |
78 |
78 |
$8K |
| A7031 |
Replacement facemask interfa |
215 |
215 |
$8K |
| E0973 |
W/ch access det adj armrest |
28 |
27 |
$8K |
| A6256 |
Absorpt drg > 48 sq in w/bdr |
103 |
103 |
$8K |
| A6447 |
Conform band s w >=5"/yd |
208 |
208 |
$6K |
| A5112 |
Urinary leg bag |
86 |
85 |
$5K |
| E0156 |
Walker seat attachment |
431 |
428 |
$5K |
| A6454 |
Self-adher band w>=3" <5"/yd |
133 |
133 |
$5K |
| A6250 |
Skin seal protect moisturizr |
1,134 |
1,131 |
$5K |
| A7038 |
Pos airway pressure filter |
1,160 |
1,154 |
$5K |
| E0295 |
Hosp bed semi-elect w/o matt |
27 |
26 |
$4K |
| A7036 |
Pos airway press chinstrap |
606 |
605 |
$4K |
| K0739 |
Repair/svc dme non-oxygen eq |
24 |
24 |
$4K |
| A4402 |
Lubricant per ounce |
424 |
424 |
$3K |
| A6402 |
Sterile gauze <= 16 sq in |
110 |
109 |
$2K |
| A4332 |
Lube sterile packet |
264 |
263 |
$2K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
26 |
26 |
$2K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
16 |
15 |
$2K |
| A7032 |
Replacement nasal cushion |
81 |
81 |
$2K |
| A6266 |
Impreg gauze no h20/sal/yard |
12 |
12 |
$1K |
| A7033 |
Replacement nasal pillows |
16 |
16 |
$790.79 |
| A7005 |
Nondisposable nebulizer set |
32 |
31 |
$743.40 |
| A6549 |
Grad com garm noc day use |
146 |
65 |
$723.06 |
| 99243 |
|
12 |
12 |
$649.85 |
| E0971 |
Wheelchair anti-tipping devi |
12 |
12 |
$420.84 |
| A7015 |
Aerosol mask used w nebulize |
18 |
18 |
$12.16 |