| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
1,217 |
1,139 |
$130K |
| T4528 |
Adult size pull-on xl |
703 |
669 |
$87K |
| B4150 |
Ef complet w/intact nutrient |
1,314 |
1,003 |
$76K |
| E1390 |
Oxygen concentrator |
1,813 |
1,666 |
$71K |
| T4535 |
Disposable liner/shield/pad |
1,301 |
1,212 |
$70K |
| T4541 |
Large disposable underpad |
2,061 |
1,893 |
$64K |
| T4526 |
Adult size pull-on med |
468 |
456 |
$52K |
| E0570 |
Nebulizer with compression |
1,744 |
1,639 |
$43K |
| A4670 |
Automatic bp monitor, dial |
1,148 |
1,073 |
$37K |
| K0001 |
Standard wheelchair |
1,402 |
1,307 |
$30K |
| A4520 |
Incontinence garment anytype |
169 |
156 |
$25K |
| T4543 |
Adult disp brief/diap abv xl |
82 |
77 |
$23K |
| E0431 |
Portable gaseous 02 |
1,052 |
980 |
$17K |
| T4534 |
Youth size pull-on |
169 |
169 |
$16K |
| E0601 |
Cont airway pressure device |
399 |
373 |
$15K |
| B4152 |
Ef calorie dense>/=1.5kcal |
187 |
143 |
$14K |
| E0260 |
Hosp bed semi-electr w/ matt |
378 |
344 |
$11K |
| A5500 |
Diab shoe for density insert |
425 |
263 |
$8K |
| A5513 |
Multi den insert custom mold |
251 |
173 |
$6K |
| T4525 |
Adult size pull-on sm |
54 |
54 |
$5K |
| T4537 |
Reusable underpad bed size |
130 |
127 |
$4K |
| A4253 |
Blood glucose/reagent strips |
698 |
667 |
$3K |
| A5514 |
Mult den insert dir carv/cam |
150 |
71 |
$1K |
| A4927 |
Non-sterile gloves |
53 |
53 |
$827.30 |
| E0143 |
Walker folding wheeled w/o s |
27 |
24 |
$674.26 |
| A7035 |
Pos airway press headgear |
26 |
26 |
$451.79 |
| A7037 |
Pos airway pressure tubing |
13 |
13 |
$154.78 |
| A7039 |
Filter, non disposable w pap |
16 |
15 |
$99.73 |
| E0156 |
Walker seat attachment |
15 |
13 |
$75.00 |
| A7038 |
Pos airway pressure filter |
16 |
15 |
$26.66 |