| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
20,102 |
11,549 |
$468K |
| B4152 |
Ef calorie dense>/=1.5kcal |
2,750 |
1,853 |
$208K |
| K0001 |
Standard wheelchair |
12,729 |
8,430 |
$150K |
| E0260 |
Hosp bed semi-electr w/ matt |
8,684 |
4,567 |
$92K |
| T4524 |
Adult size brief/diaper xl |
545 |
511 |
$67K |
| B4035 |
Enteral feed supp pump per d |
2,117 |
1,347 |
$63K |
| E0143 |
Walker folding wheeled w/o s |
3,019 |
1,937 |
$60K |
| B4150 |
Ef complet w/intact nutrient |
971 |
576 |
$46K |
| E0570 |
Nebulizer with compression |
9,753 |
5,990 |
$37K |
| E0431 |
Portable gaseous 02 |
17,961 |
10,374 |
$36K |
| E0163 |
Commode chair with fixed arm |
2,485 |
1,544 |
$27K |
| B4034 |
Enter feed supkit syr by day |
2,906 |
1,731 |
$25K |
| K0195 |
Elevating whlchair leg rests |
7,865 |
5,178 |
$16K |
| A4624 |
Tracheal suction tube |
347 |
248 |
$16K |
| E0601 |
Cont airway pressure device |
839 |
529 |
$16K |
| E0630 |
Patient lift hydraulic |
2,403 |
1,253 |
$15K |
| E0971 |
Wheelchair anti-tipping devi |
1,623 |
1,221 |
$14K |
| A4450 |
Non-waterproof tape |
3,894 |
2,386 |
$11K |
| B4154 |
Ef spec metabolic noninherit |
267 |
166 |
$11K |
| A4554 |
Disposable underpads |
279 |
268 |
$10K |
| K0003 |
Lightweight wheelchair |
1,191 |
703 |
$8K |
| A6402 |
Sterile gauze <= 16 sq in |
4,266 |
2,538 |
$6K |
| E0470 |
Rad w/o backup non-inv intfc |
250 |
140 |
$6K |
| E0600 |
Suction pump portab hom modl |
1,008 |
625 |
$6K |
| A4927 |
Non-sterile gloves |
545 |
438 |
$6K |
| A4629 |
Tracheostomy care kit |
328 |
217 |
$5K |
| E0978 |
W/c acc,saf belt pelv strap |
534 |
502 |
$4K |
| A4456 |
Adhesive remover, wipes |
357 |
313 |
$4K |
| E1392 |
Portable oxygen concentrator |
1,393 |
743 |
$2K |
| K0006 |
Heavy duty wheelchair |
132 |
87 |
$1K |
| A7000 |
Disposable canister for pump |
830 |
545 |
$1K |
| E1038 |
Transport chair pt wt<=300lb |
1,842 |
962 |
$1K |
| A7005 |
Nondisposable nebulizer set |
588 |
422 |
$1K |
| E0261 |
Hosp bed semi-electr w/o mat |
397 |
240 |
$1K |
| B9002 |
Enter nutr inf pump any type |
125 |
81 |
$1K |
| E0562 |
Humidifier heated used w pap |
153 |
115 |
$1K |
| E0776 |
Iv pole |
232 |
155 |
$1K |
| E0156 |
Walker seat attachment |
505 |
297 |
$612.47 |
| A7526 |
Tracheostomy tube collar |
274 |
192 |
$569.25 |
| A7002 |
Tubing used w suction pump |
856 |
558 |
$474.62 |
| E2601 |
Gen w/c cushion wdth < 22 in |
62 |
40 |
$276.00 |
| A7015 |
Aerosol mask used w nebulize |
865 |
623 |
$249.68 |
| A7030 |
Cpap full face mask |
28 |
16 |
$218.03 |
| E2611 |
Gen use back cush wdth <22in |
25 |
16 |
$161.44 |
| A7035 |
Pos airway press headgear |
80 |
49 |
$44.70 |
| A4628 |
Oropharyngeal suction cath |
46 |
26 |
$32.24 |
| A7037 |
Pos airway pressure tubing |
101 |
62 |
$1.91 |
| A7039 |
Filter, non disposable w pap |
26 |
15 |
$1.44 |
| A7038 |
Pos airway pressure filter |
48 |
31 |
$0.00 |