| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
13,848 |
12,693 |
$708K |
| A4927 |
Non-sterile gloves |
8,487 |
7,552 |
$300K |
| A7030 |
Cpap full face mask |
3,166 |
3,030 |
$252K |
| T4527 |
Adult size pull-on lg |
2,152 |
1,978 |
$251K |
| E0601 |
Cont airway pressure device |
6,969 |
6,451 |
$231K |
| T4541 |
Large disposable underpad |
5,561 |
5,144 |
$190K |
| T4526 |
Adult size pull-on med |
1,553 |
1,401 |
$154K |
| T2028 |
Special supply, nos waiver |
2,187 |
1,679 |
$151K |
| A4604 |
Tubing with heating element |
4,387 |
4,199 |
$138K |
| B4035 |
Enteral feed supp pump per d |
903 |
779 |
$129K |
| A7034 |
Nasal application device |
2,246 |
2,143 |
$109K |
| E0562 |
Humidifier heated used w pap |
954 |
894 |
$105K |
| A7031 |
Replacement facemask interfa |
3,512 |
3,279 |
$103K |
| T4528 |
Adult size pull-on xl |
833 |
789 |
$98K |
| S5161 |
Emer rspns sys serv permonth |
1,712 |
1,514 |
$89K |
| E0431 |
Portable gaseous 02 |
7,287 |
6,621 |
$79K |
| K0108 |
W/c component-accessory nos |
818 |
426 |
$75K |
| T4523 |
Adult size brief/diaper lg |
763 |
654 |
$65K |
| T4522 |
Adult size brief/diaper med |
788 |
668 |
$62K |
| E1392 |
Portable oxygen concentrator |
3,406 |
3,100 |
$58K |
| A7035 |
Pos airway press headgear |
3,484 |
3,324 |
$55K |
| A7032 |
Replacement nasal cushion |
1,610 |
1,492 |
$42K |
| E1028 |
W/c manual swingaway |
1,025 |
722 |
$33K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,640 |
1,073 |
$29K |
| A7038 |
Pos airway pressure filter |
6,595 |
6,161 |
$26K |
| E0570 |
Nebulizer with compression |
4,595 |
4,252 |
$24K |
| K0001 |
Standard wheelchair |
1,729 |
1,587 |
$23K |
| T4535 |
Disposable liner/shield/pad |
367 |
333 |
$22K |
| A7033 |
Replacement nasal pillows |
900 |
828 |
$20K |
| B4161 |
Ef ped hydrolyzed/amino acid |
34 |
24 |
$19K |
| A7046 |
Repl water chamber, pap dev |
1,893 |
1,786 |
$18K |
| A4322 |
Irrigation syringe |
515 |
462 |
$16K |
| E0260 |
Hosp bed semi-electr w/ matt |
643 |
544 |
$14K |
| E0470 |
Rad w/o backup non-inv intfc |
161 |
156 |
$14K |
| E0434 |
Portable liquid 02 |
797 |
693 |
$11K |
| E1399 |
Durable medical equipment mi |
52 |
27 |
$11K |
| T2029 |
Special med equip, noswaiver |
14 |
13 |
$10K |
| T4534 |
Youth size pull-on |
93 |
75 |
$10K |
| T4543 |
Adult disp brief/diap abv xl |
51 |
49 |
$10K |
| E0445 |
Oximeter non-invasive |
40 |
36 |
$9K |
| B9002 |
Enter nutr inf pump any type |
130 |
116 |
$7K |
| T4521 |
Adult size brief/diaper sm |
121 |
103 |
$7K |
| A4357 |
Bedside drainage bag |
972 |
869 |
$6K |
| T4537 |
Reusable underpad bed size |
162 |
140 |
$5K |
| A7039 |
Filter, non disposable w pap |
949 |
907 |
$5K |
| E0143 |
Walker folding wheeled w/o s |
95 |
91 |
$3K |
| E0439 |
Stationary liquid 02 |
76 |
62 |
$2K |
| A4409 |
Ost skn barr convex <=4 sq i |
29 |
24 |
$2K |
| A7003 |
Nebulizer administration set |
1,113 |
1,037 |
$2K |
| E0955 |
Cushioned headrest |
45 |
40 |
$2K |
| A4402 |
Lubricant per ounce |
314 |
256 |
$2K |
| B4088 |
Gastro/jejuno tube, low-pro |
12 |
12 |
$2K |
| A7036 |
Pos airway press chinstrap |
189 |
178 |
$1K |
| B4152 |
Ef calorie dense>/=1.5kcal |
13 |
12 |
$1K |
| A4358 |
Urinary leg or abdomen bag |
185 |
158 |
$1K |
| T4525 |
Adult size pull-on sm |
16 |
13 |
$974.08 |
| T4530 |
Ped size brief/diaper lg |
21 |
12 |
$667.22 |
| B4150 |
Ef complet w/intact nutrient |
14 |
12 |
$433.20 |
| E0776 |
Iv pole |
27 |
24 |
$365.65 |
| A6402 |
Sterile gauze <= 16 sq in |
71 |
48 |
$238.65 |
| K0195 |
Elevating whlchair leg rests |
24 |
24 |
$221.53 |
| A4331 |
Extension drainage tubing |
13 |
12 |
$51.36 |
| A7015 |
Aerosol mask used w nebulize |
14 |
13 |
$9.44 |
| A4520 |
Incontinence garment anytype |
1,836 |
1,171 |
$0.00 |
| E0442 |
Stationary o2 contents, liq |
14 |
12 |
$0.00 |
| B9998 |
Enteral supp not otherwise c |
19 |
14 |
$0.00 |
| A9279 |
Monitoring feature/devicenoc |
94 |
94 |
$0.00 |