| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4534 |
Youth size pull-on |
2,401 |
2,124 |
$445K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,153 |
822 |
$208K |
| E0601 |
Cont airway pressure device |
970 |
871 |
$61K |
| T4526 |
Adult size pull-on med |
299 |
280 |
$49K |
| E1390 |
Oxygen concentrator |
996 |
928 |
$33K |
| T4533 |
Youth size brief/diaper |
185 |
178 |
$22K |
| K0003 |
Lightweight wheelchair |
1,203 |
1,144 |
$21K |
| A7031 |
Replacement facemask interfa |
416 |
393 |
$14K |
| E0260 |
Hosp bed semi-electr w/ matt |
174 |
169 |
$8K |
| A7038 |
Pos airway pressure filter |
870 |
830 |
$5K |
| E0570 |
Nebulizer with compression |
243 |
238 |
$3K |
| A7037 |
Pos airway pressure tubing |
102 |
98 |
$2K |
| E0165 |
Commode chair with detacharm |
204 |
202 |
$1K |
| E0431 |
Portable gaseous 02 |
628 |
593 |
$1K |
| A7035 |
Pos airway press headgear |
29 |
28 |
$674.50 |
| A7039 |
Filter, non disposable w pap |
25 |
24 |
$119.06 |