| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
11,845 |
11,639 |
$342K |
| T4535 |
Disposable liner/shield/pad |
10,958 |
10,222 |
$242K |
| T4523 |
Adult size brief/diaper lg |
3,679 |
3,544 |
$186K |
| T4524 |
Adult size brief/diaper xl |
2,727 |
2,675 |
$182K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,980 |
1,627 |
$143K |
| T4522 |
Adult size brief/diaper med |
2,832 |
2,662 |
$110K |
| E0466 |
Home vent non-invasive inter |
181 |
180 |
$100K |
| E1399 |
Durable medical equipment mi |
972 |
915 |
$83K |
| E0570 |
Nebulizer with compression |
864 |
858 |
$83K |
| T4543 |
Adult disp brief/diap abv xl |
614 |
608 |
$71K |
| E1390 |
Oxygen concentrator |
602 |
601 |
$71K |
| T4539 |
Reuse diaper/brief any size |
2,840 |
2,576 |
$63K |
| T4537 |
Reusable underpad bed size |
3,001 |
2,735 |
$59K |
| T4527 |
Adult size pull-on lg |
1,244 |
1,173 |
$53K |
| A4253 |
Blood glucose/reagent strips |
694 |
620 |
$51K |
| T4526 |
Adult size pull-on med |
1,181 |
1,101 |
$44K |
| A4927 |
Non-sterile gloves |
6,625 |
6,448 |
$33K |
| T4528 |
Adult size pull-on xl |
578 |
569 |
$32K |
| B4150 |
Ef complet w/intact nutrient |
394 |
393 |
$28K |
| B4154 |
Ef spec metabolic noninherit |
230 |
228 |
$28K |
| E0652 |
Pneum compres w/cal pressure |
16 |
16 |
$26K |
| E0240 |
Bath/shower chair |
894 |
893 |
$23K |
| E0241 |
Bath tub wall rail |
617 |
614 |
$23K |
| L0650 |
Lso sc r ant/pos pnl pre ots |
42 |
42 |
$20K |
| E0601 |
Cont airway pressure device |
478 |
478 |
$19K |
| B4152 |
Ef calorie dense>/=1.5kcal |
196 |
192 |
$16K |
| E0431 |
Portable gaseous 02 |
554 |
553 |
$14K |
| A4353 |
Intermittent urinary cath |
34 |
32 |
$13K |
| E0445 |
Oximeter non-invasive |
99 |
99 |
$13K |
| T4521 |
Adult size brief/diaper sm |
283 |
258 |
$13K |
| E0243 |
Toilet rail |
231 |
231 |
$12K |
| T4540 |
Reusable underpad chair size |
621 |
612 |
$11K |
| A4670 |
Automatic bp monitor, dial |
162 |
162 |
$11K |
| A7030 |
Cpap full face mask |
127 |
127 |
$10K |
| A7031 |
Replacement facemask interfa |
118 |
118 |
$9K |
| E0143 |
Walker folding wheeled w/o s |
127 |
127 |
$8K |
| A7032 |
Replacement nasal cushion |
102 |
102 |
$6K |
| A4259 |
Lancets per box |
678 |
610 |
$6K |
| E0562 |
Humidifier heated used w pap |
50 |
50 |
$6K |
| A7034 |
Nasal application device |
141 |
141 |
$5K |
| A4351 |
Straight tip urine catheter |
27 |
26 |
$4K |
| A7005 |
Nondisposable nebulizer set |
276 |
276 |
$4K |
| T4541 |
Large disposable underpad |
78 |
78 |
$3K |
| K0001 |
Standard wheelchair |
151 |
151 |
$3K |
| A7035 |
Pos airway press headgear |
189 |
189 |
$2K |
| A7037 |
Pos airway pressure tubing |
231 |
231 |
$2K |
| A4409 |
Ost skn barr convex <=4 sq i |
25 |
24 |
$2K |
| E0244 |
Toilet seat raised |
128 |
128 |
$2K |
| A4335 |
Incontinence supply |
157 |
61 |
$2K |
| A4245 |
Alcohol wipes per box |
621 |
601 |
$2K |
| A7038 |
Pos airway pressure filter |
241 |
241 |
$2K |
| T4525 |
Adult size pull-on sm |
29 |
28 |
$1K |
| E0260 |
Hosp bed semi-electr w/ matt |
28 |
28 |
$1K |
| E0607 |
Blood glucose monitor home |
19 |
14 |
$995.54 |
| A5120 |
Skin barrier, wipe or swab |
210 |
200 |
$928.30 |
| A4456 |
Adhesive remover, wipes |
100 |
95 |
$776.26 |
| A6250 |
Skin seal protect moisturizr |
40 |
37 |
$766.16 |
| A5063 |
Drain ostomy pouch w/flange |
28 |
26 |
$678.90 |
| A7015 |
Aerosol mask used w nebulize |
641 |
639 |
$674.94 |
| A7046 |
Repl water chamber, pap dev |
61 |
61 |
$533.82 |
| K0195 |
Elevating whlchair leg rests |
43 |
43 |
$401.41 |
| B4100 |
Food thickener oral |
16 |
16 |
$400.68 |
| E0600 |
Suction pump portab hom modl |
13 |
13 |
$176.88 |
| A6402 |
Sterile gauze <= 16 sq in |
12 |
12 |
$174.32 |
| A7039 |
Filter, non disposable w pap |
66 |
66 |
$124.83 |
| A7000 |
Disposable canister for pump |
12 |
12 |
$97.18 |
| A4371 |
Skin barrier powder per oz |
13 |
13 |
$47.72 |
| A4402 |
Lubricant per ounce |
16 |
16 |
$30.20 |
| E0603 |
Electric breast pump |
17 |
17 |
$0.00 |