| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
4,701 |
4,111 |
$157K |
| T4541 |
Large disposable underpad |
2,675 |
1,878 |
$72K |
| T4535 |
Disposable liner/shield/pad |
1,961 |
1,292 |
$65K |
| E0431 |
Portable gaseous 02 |
3,380 |
2,977 |
$49K |
| E0260 |
Hosp bed semi-electr w/ matt |
415 |
388 |
$21K |
| E0570 |
Nebulizer with compression |
681 |
647 |
$16K |
| A4927 |
Non-sterile gloves |
1,589 |
900 |
$15K |
| K0001 |
Standard wheelchair |
720 |
675 |
$13K |
| A4253 |
Blood glucose/reagent strips |
147 |
137 |
$530.91 |
| A4670 |
Automatic bp monitor, dial |
13 |
12 |
$383.05 |
| A5500 |
Diab shoe for density insert |
63 |
16 |
$363.96 |
| A5512 |
Multi den insert direct form |
64 |
17 |
$360.88 |
| A7003 |
Nebulizer administration set |
12 |
12 |
$34.03 |