| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0603 |
Electric breast pump |
3,661 |
3,657 |
$553K |
| E0601 |
Cont airway pressure device |
4,572 |
4,505 |
$277K |
| A4554 |
Disposable underpads |
2,042 |
2,029 |
$146K |
| T4522 |
Adult size brief/diaper med |
971 |
959 |
$93K |
| E0562 |
Humidifier heated used w pap |
2,106 |
2,076 |
$87K |
| A4239 |
Non-adju cgm supply allow |
925 |
922 |
$81K |
| T4523 |
Adult size brief/diaper lg |
581 |
579 |
$69K |
| E1390 |
Oxygen concentrator |
932 |
926 |
$50K |
| A7034 |
Nasal application device |
1,390 |
1,389 |
$36K |
| A7030 |
Cpap full face mask |
583 |
582 |
$31K |
| T4524 |
Adult size brief/diaper xl |
132 |
131 |
$19K |
| A7035 |
Pos airway press headgear |
1,654 |
1,651 |
$16K |
| K0553 |
Ther cgm supply allowance |
124 |
120 |
$16K |
| A7037 |
Pos airway pressure tubing |
1,261 |
1,259 |
$11K |
| A7038 |
Pos airway pressure filter |
3,035 |
3,031 |
$10K |
| L0621 |
Sio flex pelvic/sacr pre ots |
161 |
161 |
$9K |
| A4670 |
Automatic bp monitor, dial |
197 |
197 |
$9K |
| A7032 |
Replacement nasal cushion |
287 |
287 |
$7K |
| A7031 |
Replacement facemask interfa |
273 |
271 |
$6K |
| E0240 |
Bath/shower chair |
180 |
179 |
$6K |
| K0001 |
Standard wheelchair |
455 |
452 |
$6K |
| A4927 |
Non-sterile gloves |
1,218 |
1,208 |
$5K |
| E0570 |
Nebulizer with compression |
104 |
103 |
$5K |
| E0470 |
Rad w/o backup non-inv intfc |
77 |
75 |
$4K |
| E0260 |
Hosp bed semi-electr w/ matt |
238 |
234 |
$4K |
| T4535 |
Disposable liner/shield/pad |
124 |
124 |
$4K |
| E2103 |
Non-adju cgm receiver/mon |
28 |
27 |
$2K |
| A4604 |
Tubing with heating element |
412 |
411 |
$2K |
| E0143 |
Walker folding wheeled w/o s |
52 |
52 |
$1K |
| E0431 |
Portable gaseous 02 |
41 |
40 |
$745.61 |
| E0241 |
Bath tub wall rail |
12 |
12 |
$410.24 |
| A7046 |
Repl water chamber, pap dev |
133 |
133 |
$337.53 |
| T4537 |
Reusable underpad bed size |
12 |
12 |
$235.57 |
| A7015 |
Aerosol mask used w nebulize |
198 |
198 |
$210.75 |
| A7033 |
Replacement nasal pillows |
12 |
12 |
$126.49 |
| A7039 |
Filter, non disposable w pap |
142 |
140 |
$119.49 |
| K0195 |
Elevating whlchair leg rests |
57 |
54 |
$111.43 |