| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Large disposable underpad |
13,217 |
13,052 |
$679K |
| T4523 |
Adult size brief/diaper lg |
3,736 |
3,731 |
$389K |
| J1642 |
Inj heparin sodium per 10 u |
2,170 |
1,808 |
$365K |
| E1390 |
Oxygen concentrator |
7,002 |
6,770 |
$219K |
| T4527 |
Adult size pull-on lg |
2,231 |
2,226 |
$179K |
| B4154 |
Ef spec metabolic noninherit |
1,111 |
1,000 |
$164K |
| T4524 |
Adult size brief/diaper xl |
1,544 |
1,500 |
$156K |
| T4526 |
Adult size pull-on med |
2,255 |
2,253 |
$148K |
| K0001 |
Standard wheelchair |
11,368 |
10,873 |
$146K |
| B4150 |
Ef complet w/intact nutrient |
1,613 |
1,406 |
$142K |
| E0776 |
Iv pole |
2,891 |
2,735 |
$137K |
| T4535 |
Disposable liner/shield/pad |
1,888 |
1,882 |
$115K |
| A6402 |
Sterile gauze <= 16 sq in |
3,910 |
3,854 |
$97K |
| B4035 |
Enteral feed supp pump per d |
1,978 |
1,784 |
$95K |
| T4522 |
Adult size brief/diaper med |
857 |
845 |
$84K |
| A6224 |
Gauze > 48 in no w/sal w/o b |
810 |
743 |
$81K |
| A4223 |
Infusion supplies w/o pump |
2,873 |
2,513 |
$60K |
| B4034 |
Enter feed supkit syr by day |
1,996 |
1,857 |
$55K |
| E0143 |
Walker folding wheeled w/o s |
2,551 |
2,531 |
$51K |
| T4528 |
Adult size pull-on xl |
482 |
482 |
$40K |
| A6403 |
Sterile gauze>16 <= 48 sq in |
820 |
747 |
$33K |
| E2611 |
Gen use back cush wdth <22in |
941 |
888 |
$31K |
| K0195 |
Elevating whlchair leg rests |
11,931 |
11,424 |
$31K |
| E0431 |
Portable gaseous 02 |
6,875 |
6,642 |
$29K |
| E0600 |
Suction pump portab hom modl |
1,132 |
1,086 |
$19K |
| E0163 |
Commode chair with fixed arm |
759 |
757 |
$17K |
| B4152 |
Ef calorie dense>/=1.5kcal |
210 |
193 |
$14K |
| E0570 |
Nebulizer with compression |
4,161 |
4,016 |
$10K |
| A6257 |
Transparent film <= 16 sq in |
2,881 |
2,604 |
$8K |
| E2601 |
Gen w/c cushion wdth < 22 in |
943 |
922 |
$8K |
| A4305 |
Drug delivery system >=50 ml |
427 |
373 |
$7K |
| E0971 |
Wheelchair anti-tipping devi |
927 |
905 |
$7K |
| E0443 |
Portable 02 contents, gas |
392 |
385 |
$6K |
| A7002 |
Tubing used w suction pump |
337 |
336 |
$6K |
| E0156 |
Walker seat attachment |
1,818 |
1,804 |
$6K |
| E0245 |
Tub stool or bench |
102 |
102 |
$6K |
| E0978 |
W/c acc,saf belt pelv strap |
908 |
888 |
$5K |
| E1038 |
Transport chair pt wt<=300lb |
760 |
734 |
$4K |
| S1015 |
Iv tubing extension set |
657 |
531 |
$2K |
| A7038 |
Pos airway pressure filter |
441 |
421 |
$2K |
| K0003 |
Lightweight wheelchair |
55 |
54 |
$1K |
| A4624 |
Tracheal suction tube |
26 |
26 |
$671.50 |
| A4335 |
Incontinence supply |
77 |
77 |
$534.55 |
| A7005 |
Nondisposable nebulizer set |
149 |
148 |
$533.45 |
| A4210 |
Nonneedle injection device |
97 |
88 |
$528.62 |
| A4628 |
Oropharyngeal suction cath |
91 |
91 |
$485.03 |
| A9999 |
Dme supply or accessory, nos |
98 |
84 |
$403.97 |
| E0149 |
Heavy duty wheeled walker |
96 |
94 |
$302.71 |
| A6250 |
Skin seal protect moisturizr |
12 |
12 |
$193.44 |
| A4221 |
Supp non-insulin inf cath/wk |
19 |
12 |
$147.00 |
| G0333 |
Dispense fee initial 30 day |
17 |
16 |
$129.01 |
| Q0513 |
Disp fee inhal drugs/30 days |
15 |
15 |
$127.32 |
| A7015 |
Aerosol mask used w nebulize |
121 |
121 |
$34.78 |