| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
2,834 |
2,582 |
$238K |
| E0601 |
Cont airway pressure device |
1,716 |
1,519 |
$103K |
| A7030 |
Cpap full face mask |
885 |
789 |
$88K |
| A7031 |
Replacement facemask interfa |
2,311 |
2,091 |
$85K |
| A4604 |
Tubing with heating element |
1,657 |
1,527 |
$69K |
| T4526 |
Adult size pull-on med |
822 |
695 |
$67K |
| A4239 |
Non-adju cgm supply allow |
407 |
365 |
$58K |
| A7032 |
Replacement nasal cushion |
908 |
854 |
$43K |
| A4927 |
Non-sterile gloves |
1,749 |
1,469 |
$34K |
| K0553 |
Ther cgm supply allowance |
237 |
193 |
$34K |
| A7034 |
Nasal application device |
384 |
351 |
$26K |
| T2028 |
Special supply, nos waiver |
614 |
353 |
$24K |
| A7035 |
Pos airway press headgear |
930 |
846 |
$21K |
| A7038 |
Pos airway pressure filter |
3,693 |
3,411 |
$20K |
| A4206 |
1 cc sterile syringe&needle |
406 |
376 |
$16K |
| E0431 |
Portable gaseous 02 |
941 |
867 |
$15K |
| T4541 |
Large disposable underpad |
762 |
663 |
$15K |
| A4253 |
Blood glucose/reagent strips |
1,349 |
1,252 |
$14K |
| T4535 |
Disposable liner/shield/pad |
118 |
111 |
$10K |
| T4522 |
Adult size brief/diaper med |
91 |
79 |
$8K |
| E0570 |
Nebulizer with compression |
351 |
340 |
$7K |
| L3908 |
Who cock-up nonmolde pre ots |
145 |
133 |
$7K |
| A7046 |
Repl water chamber, pap dev |
505 |
463 |
$6K |
| T4527 |
Adult size pull-on lg |
28 |
25 |
$3K |
| L4361 |
Pneuma/vac walk boot pre ots |
12 |
12 |
$3K |
| A7033 |
Replacement nasal pillows |
56 |
49 |
$2K |
| E0114 |
Crutch underarm pair no wood |
25 |
25 |
$1K |
| K0739 |
Repair/svc dme non-oxygen eq |
55 |
42 |
$825.90 |
| A4259 |
Lancets per box |
14 |
14 |
$15.62 |