| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
6,371 |
5,231 |
$185K |
| E1390 |
Oxygen concentrator |
6,024 |
4,442 |
$180K |
| T4527 |
Adult size pull-on lg |
2,045 |
1,890 |
$106K |
| T4528 |
Adult size pull-on xl |
1,449 |
1,289 |
$92K |
| T5999 |
Supply, nos |
11,003 |
8,269 |
$85K |
| X1922 |
|
225 |
222 |
$77K |
| E0601 |
Cont airway pressure device |
3,219 |
2,189 |
$73K |
| T4535 |
Disposable liner/shield/pad |
2,244 |
1,994 |
$63K |
| E0570 |
Nebulizer with compression |
3,280 |
2,297 |
$49K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,923 |
1,269 |
$42K |
| T4526 |
Adult size pull-on med |
900 |
844 |
$40K |
| K0738 |
Portable gas oxygen system |
2,968 |
2,132 |
$35K |
| X1939 |
|
474 |
458 |
$30K |
| A7030 |
Cpap full face mask |
866 |
585 |
$28K |
| B4035 |
Enteral feed supp pump per d |
113 |
95 |
$25K |
| A7031 |
Replacement facemask interfa |
1,103 |
789 |
$22K |
| A4604 |
Tubing with heating element |
1,745 |
1,150 |
$19K |
| K0001 |
Standard wheelchair |
1,313 |
934 |
$15K |
| T4523 |
Adult size brief/diaper lg |
252 |
182 |
$15K |
| A4927 |
Non-sterile gloves |
1,352 |
791 |
$15K |
| A7035 |
Pos airway press headgear |
1,122 |
747 |
$9K |
| A7034 |
Nasal application device |
387 |
241 |
$8K |
| K0003 |
Lightweight wheelchair |
447 |
261 |
$8K |
| A7038 |
Pos airway pressure filter |
2,546 |
1,701 |
$8K |
| B4161 |
Ef ped hydrolyzed/amino acid |
12 |
12 |
$5K |
| K0002 |
Stnd hemi (low seat) whlchr |
406 |
166 |
$5K |
| T2028 |
Special supply, nos waiver |
25 |
24 |
$5K |
| E0431 |
Portable gaseous 02 |
674 |
515 |
$4K |
| E1392 |
Portable oxygen concentrator |
582 |
474 |
$4K |
| T4524 |
Adult size brief/diaper xl |
31 |
29 |
$4K |
| E0630 |
Patient lift hydraulic |
298 |
233 |
$4K |
| A7046 |
Repl water chamber, pap dev |
388 |
274 |
$2K |
| E0600 |
Suction pump portab hom modl |
55 |
42 |
$1K |
| K0195 |
Elevating whlchair leg rests |
380 |
250 |
$1K |
| A7005 |
Nondisposable nebulizer set |
52 |
39 |
$856.55 |
| E0143 |
Walker folding wheeled w/o s |
79 |
54 |
$689.74 |
| A7000 |
Disposable canister for pump |
17 |
13 |
$388.70 |
| B4088 |
Gastro/jejuno tube, low-pro |
13 |
12 |
$352.02 |
| A7037 |
Pos airway pressure tubing |
27 |
13 |
$160.06 |
| A7003 |
Nebulizer administration set |
94 |
68 |
$145.60 |
| A7002 |
Tubing used w suction pump |
16 |
12 |
$38.51 |