| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0570 |
Nebulizer, with compressor |
1,055 |
1,055 |
$58K |
| A4335 |
Incontinence supply; miscellaneous |
441 |
414 |
$26K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
413 |
413 |
$15K |
| T4541 |
Incontinence product, disposable underpad, large, each |
105 |
100 |
$6K |
| A4927 |
Gloves, non-sterile, per 100 |
111 |
102 |
$3K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
112 |
112 |
$2K |
| E1392 |
Portable oxygen concentrator, rental |
38 |
38 |
$331.18 |