| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
1,502 |
1,436 |
$178K |
| E1390 |
Oxygen concentrator |
7,629 |
6,135 |
$154K |
| T4542 |
Small disposable underpad |
3,675 |
3,512 |
$145K |
| T4535 |
Disposable liner/shield/pad |
2,096 |
1,963 |
$123K |
| T4526 |
Adult size pull-on med |
1,248 |
1,142 |
$123K |
| T4528 |
Adult size pull-on xl |
781 |
729 |
$103K |
| B4150 |
Ef complet w/intact nutrient |
951 |
704 |
$89K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,110 |
903 |
$37K |
| E0431 |
Portable gaseous 02 |
4,692 |
3,868 |
$29K |
| K0001 |
Standard wheelchair |
1,428 |
1,134 |
$25K |
| A4927 |
Non-sterile gloves |
1,312 |
1,204 |
$17K |
| E0570 |
Nebulizer with compression |
2,515 |
2,087 |
$11K |
| T4543 |
Adult disp brief/diap abv xl |
39 |
36 |
$11K |
| E0470 |
Rad w/o backup non-inv intfc |
216 |
173 |
$9K |
| E0601 |
Cont airway pressure device |
555 |
463 |
$8K |
| E0971 |
Wheelchair anti-tipping devi |
2,147 |
890 |
$3K |
| E0562 |
Humidifier heated used w pap |
284 |
228 |
$2K |
| A7030 |
Cpap full face mask |
106 |
85 |
$2K |
| A7038 |
Pos airway pressure filter |
411 |
307 |
$764.34 |
| A7035 |
Pos airway press headgear |
65 |
50 |
$316.83 |
| A4604 |
Tubing with heating element |
17 |
12 |
$192.67 |
| A7037 |
Pos airway pressure tubing |
18 |
16 |
$101.89 |