| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
13,905 |
13,290 |
$585K |
| E0431 |
Portable gaseous 02 |
11,221 |
10,796 |
$86K |
| E0601 |
Cont airway pressure device |
1,343 |
1,270 |
$38K |
| A7030 |
Cpap full face mask |
554 |
546 |
$27K |
| K0001 |
Standard wheelchair |
2,107 |
1,948 |
$25K |
| A7031 |
Replacement facemask interfa |
767 |
733 |
$19K |
| E0570 |
Nebulizer with compression |
482 |
467 |
$17K |
| A4351 |
Straight tip urine catheter |
107 |
102 |
$16K |
| E0562 |
Humidifier heated used w pap |
370 |
363 |
$15K |
| B4035 |
Enteral feed supp pump per d |
907 |
890 |
$12K |
| T4534 |
Youth size pull-on |
329 |
319 |
$12K |
| E0470 |
Rad w/o backup non-inv intfc |
205 |
202 |
$10K |
| A4604 |
Tubing with heating element |
360 |
359 |
$9K |
| E0260 |
Hosp bed semi-electr w/ matt |
384 |
331 |
$7K |
| A7038 |
Pos airway pressure filter |
2,360 |
2,238 |
$6K |
| A7034 |
Nasal application device |
170 |
168 |
$5K |
| A7035 |
Pos airway press headgear |
561 |
552 |
$5K |
| T4533 |
Youth size brief/diaper |
565 |
551 |
$5K |
| E1392 |
Portable oxygen concentrator |
327 |
313 |
$4K |
| T4530 |
Ped size brief/diaper lg |
576 |
567 |
$4K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
410 |
312 |
$4K |
| A7037 |
Pos airway pressure tubing |
469 |
463 |
$3K |
| A7032 |
Replacement nasal cushion |
70 |
68 |
$2K |
| E0471 |
Rad w/backup non inv intrfc |
26 |
26 |
$2K |
| T4527 |
Adult size pull-on lg |
42 |
42 |
$2K |
| K0195 |
Elevating whlchair leg rests |
371 |
354 |
$2K |
| A7033 |
Replacement nasal pillows |
94 |
83 |
$2K |
| B4161 |
Ef ped hydrolyzed/amino acid |
120 |
109 |
$2K |
| T4522 |
Adult size brief/diaper med |
664 |
643 |
$1K |
| T4526 |
Adult size pull-on med |
232 |
225 |
$855.70 |
| A7046 |
Repl water chamber, pap dev |
326 |
312 |
$743.61 |
| E0143 |
Walker folding wheeled w/o s |
42 |
42 |
$660.97 |
| A4649 |
Surgical supplies |
449 |
209 |
$315.62 |
| A7526 |
Tracheostomy tube collar |
31 |
24 |
$296.94 |
| A4385 |
Ost skn barrier sld ext wear |
13 |
12 |
$295.92 |
| A7005 |
Nondisposable nebulizer set |
64 |
63 |
$233.84 |
| A7000 |
Disposable canister for pump |
75 |
68 |
$220.26 |
| A7002 |
Tubing used w suction pump |
109 |
87 |
$178.24 |
| B9002 |
Enter nutr inf pump any type |
15 |
15 |
$0.00 |
| T4523 |
Adult size brief/diaper lg |
678 |
653 |
$0.00 |