| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
4,984 |
4,358 |
$159K |
| A4927 |
Non-sterile gloves |
4,772 |
4,391 |
$106K |
| T4528 |
Adult size pull-on xl |
734 |
671 |
$84K |
| T4541 |
Large disposable underpad |
2,114 |
1,983 |
$80K |
| T4526 |
Adult size pull-on med |
356 |
348 |
$49K |
| E0431 |
Portable gaseous 02 |
3,698 |
3,280 |
$42K |
| T4527 |
Adult size pull-on lg |
272 |
265 |
$32K |
| E0601 |
Cont airway pressure device |
660 |
616 |
$31K |
| A7031 |
Replacement facemask interfa |
1,559 |
1,469 |
$29K |
| E0570 |
Nebulizer with compression |
3,989 |
3,561 |
$17K |
| A4253 |
Blood glucose/reagent strips |
3,614 |
3,200 |
$16K |
| E0562 |
Humidifier heated used w pap |
663 |
616 |
$14K |
| A7037 |
Pos airway pressure tubing |
1,274 |
1,194 |
$11K |
| A7030 |
Cpap full face mask |
193 |
181 |
$11K |
| A7035 |
Pos airway press headgear |
658 |
613 |
$8K |
| A7038 |
Pos airway pressure filter |
2,035 |
1,915 |
$8K |
| T4534 |
Youth size pull-on |
12 |
12 |
$2K |
| Q0513 |
Disp fee inhal drugs/30 days |
887 |
702 |
$2K |
| T4535 |
Disposable liner/shield/pad |
27 |
26 |
$1K |
| E0260 |
Hosp bed semi-electr w/ matt |
28 |
25 |
$1K |
| A7046 |
Repl water chamber, pap dev |
71 |
67 |
$816.19 |
| A7003 |
Nebulizer administration set |
196 |
185 |
$440.40 |
| A7032 |
Replacement nasal cushion |
14 |
12 |
$373.53 |
| A4553 |
Nondisp underpads, all sizes |
12 |
12 |
$167.51 |
| J7613 |
Albuterol non-comp unit |
27 |
25 |
$118.06 |
| A7015 |
Aerosol mask used w nebulize |
40 |
37 |
$110.87 |
| A7039 |
Filter, non disposable w pap |
13 |
13 |
$30.24 |