| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
6,389 |
6,113 |
$639K |
| E1390 |
Oxygen concentrator |
13,439 |
11,499 |
$587K |
| T4526 |
Adult size pull-on med |
5,818 |
5,598 |
$483K |
| E0601 |
Cont airway pressure device |
7,047 |
6,255 |
$399K |
| T4541 |
Large disposable underpad |
8,851 |
8,579 |
$362K |
| A7030 |
Cpap full face mask |
4,804 |
4,354 |
$360K |
| T4544 |
Adlt disp und/pull on abv xl |
1,910 |
1,808 |
$341K |
| T4528 |
Adult size pull-on xl |
3,525 |
3,326 |
$339K |
| T4537 |
Reusable underpad bed size |
9,040 |
8,797 |
$317K |
| A4927 |
Non-sterile gloves |
20,536 |
19,831 |
$289K |
| T4535 |
Disposable liner/shield/pad |
5,443 |
5,094 |
$205K |
| A4604 |
Tubing with heating element |
6,827 |
6,241 |
$194K |
| E0562 |
Humidifier heated used w pap |
1,293 |
1,183 |
$188K |
| E0570 |
Nebulizer with compression |
8,325 |
7,339 |
$180K |
| S9999 |
Sales tax |
12,727 |
11,560 |
$146K |
| A4351 |
Straight tip urine catheter |
1,296 |
1,182 |
$145K |
| A7034 |
Nasal application device |
2,685 |
2,467 |
$135K |
| T4525 |
Adult size pull-on sm |
1,543 |
1,481 |
$130K |
| T4534 |
Youth size pull-on |
1,352 |
1,321 |
$128K |
| E0470 |
Rad w/o backup non-inv intfc |
1,585 |
1,328 |
$119K |
| A7035 |
Pos airway press headgear |
5,841 |
5,392 |
$110K |
| T4522 |
Adult size brief/diaper med |
1,464 |
1,384 |
$107K |
| K0823 |
Pwc gp 2 std cap chair |
923 |
780 |
$105K |
| T4532 |
Ped size pull-on lg |
1,425 |
1,401 |
$98K |
| T4524 |
Adult size brief/diaper xl |
892 |
860 |
$95K |
| K0004 |
High strength ltwt whlchr |
3,263 |
2,805 |
$84K |
| E0431 |
Portable gaseous 02 |
9,643 |
8,385 |
$80K |
| T4530 |
Ped size brief/diaper lg |
1,234 |
1,201 |
$76K |
| E0260 |
Hosp bed semi-electr w/ matt |
3,635 |
3,183 |
$69K |
| A7031 |
Replacement facemask interfa |
2,770 |
2,416 |
$59K |
| T4533 |
Youth size brief/diaper |
953 |
932 |
$59K |
| E0143 |
Walker folding wheeled w/o s |
1,825 |
1,615 |
$54K |
| A7038 |
Pos airway pressure filter |
9,437 |
8,672 |
$50K |
| E0973 |
W/ch access det adj armrest |
1,724 |
895 |
$48K |
| K0002 |
Stnd hemi (low seat) whlchr |
2,423 |
2,095 |
$42K |
| T4523 |
Adult size brief/diaper lg |
451 |
411 |
$38K |
| A7005 |
Nondisposable nebulizer set |
1,975 |
1,834 |
$37K |
| A7046 |
Repl water chamber, pap dev |
3,493 |
3,219 |
$32K |
| E2611 |
Gen use back cush wdth <22in |
403 |
360 |
$25K |
| A5500 |
Diab shoe for density insert |
498 |
349 |
$24K |
| E1028 |
W/c manual swingaway |
1,287 |
909 |
$23K |
| A4670 |
Automatic bp monitor, dial |
365 |
343 |
$22K |
| K0001 |
Standard wheelchair |
1,321 |
1,163 |
$17K |
| E0971 |
Wheelchair anti-tipping devi |
1,154 |
575 |
$15K |
| K0821 |
Pwc gp 2 std port cap chair |
117 |
93 |
$15K |
| E0156 |
Walker seat attachment |
1,401 |
1,265 |
$12K |
| K0739 |
Repair/svc dme non-oxygen eq |
454 |
371 |
$10K |
| E0630 |
Patient lift hydraulic |
331 |
302 |
$10K |
| E0961 |
Wheelchair brake extension |
974 |
479 |
$7K |
| E0114 |
Crutch underarm pair no wood |
181 |
174 |
$7K |
| E0240 |
Bath/shower chair |
42 |
41 |
$6K |
| A7032 |
Replacement nasal cushion |
356 |
312 |
$6K |
| E0978 |
W/c acc,saf belt pelv strap |
644 |
566 |
$6K |
| E0951 |
Loop heel |
1,137 |
568 |
$6K |
| A5512 |
Multi den insert direct form |
235 |
153 |
$6K |
| E2601 |
Gen w/c cushion wdth < 22 in |
365 |
314 |
$5K |
| K0003 |
Lightweight wheelchair |
191 |
164 |
$4K |
| L1810 |
Ko elastic with joints |
41 |
41 |
$3K |
| A7039 |
Filter, non disposable w pap |
403 |
365 |
$3K |
| E0181 |
Press pad alternating w/ pum |
361 |
334 |
$3K |
| A4357 |
Bedside drainage bag |
328 |
292 |
$3K |
| A6402 |
Sterile gauze <= 16 sq in |
140 |
121 |
$2K |
| L3908 |
Who cock-up nonmolde pre ots |
41 |
30 |
$2K |
| A4402 |
Lubricant per ounce |
280 |
246 |
$2K |
| K0007 |
Extra heavy duty wheelchair |
56 |
51 |
$2K |
| A7033 |
Replacement nasal pillows |
85 |
78 |
$2K |
| E0600 |
Suction pump portab hom modl |
42 |
37 |
$2K |
| A5513 |
Multi den insert custom mold |
33 |
27 |
$2K |
| E1399 |
Durable medical equipment mi |
15 |
15 |
$671.17 |
| K0006 |
Heavy duty wheelchair |
34 |
26 |
$641.86 |
| L1812 |
Ko elastic w/joints pre ots |
12 |
12 |
$630.77 |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
15 |
14 |
$601.69 |
| E0149 |
Heavy duty wheeled walker |
25 |
24 |
$588.68 |
| E0955 |
Cushioned headrest |
28 |
24 |
$497.40 |
| A5063 |
Drain ostomy pouch w/flange |
12 |
12 |
$322.21 |
| A7037 |
Pos airway pressure tubing |
17 |
13 |
$178.62 |
| A4338 |
Indwelling catheter latex |
26 |
24 |
$73.66 |
| A5120 |
Skin barrier, wipe or swab |
12 |
12 |
$70.63 |