| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4523 |
Adult size brief/diaper lg |
1,826 |
1,775 |
$274K |
| E1390 |
Oxygen concentrator |
2,779 |
2,472 |
$135K |
| T4522 |
Adult size brief/diaper med |
898 |
797 |
$123K |
| T4534 |
Youth size pull-on |
760 |
697 |
$98K |
| T4527 |
Adult size pull-on lg |
711 |
662 |
$78K |
| T4528 |
Adult size pull-on xl |
587 |
551 |
$72K |
| T4526 |
Adult size pull-on med |
730 |
676 |
$72K |
| E0570 |
Nebulizer with compression |
5,001 |
4,698 |
$54K |
| E0601 |
Cont airway pressure device |
1,223 |
1,094 |
$52K |
| B4150 |
Ef complet w/intact nutrient |
331 |
292 |
$27K |
| T4541 |
Large disposable underpad |
1,277 |
1,218 |
$25K |
| T4535 |
Disposable liner/shield/pad |
454 |
430 |
$19K |
| A4927 |
Non-sterile gloves |
1,759 |
1,327 |
$18K |
| A7037 |
Pos airway pressure tubing |
860 |
778 |
$12K |
| A7030 |
Cpap full face mask |
163 |
150 |
$12K |
| K0001 |
Standard wheelchair |
655 |
575 |
$11K |
| A7035 |
Pos airway press headgear |
615 |
563 |
$8K |
| E0431 |
Portable gaseous 02 |
758 |
708 |
$6K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
14 |
14 |
$3K |
| A7031 |
Replacement facemask interfa |
39 |
38 |
$2K |
| A7039 |
Filter, non disposable w pap |
301 |
270 |
$2K |
| T4529 |
Ped size brief/diaper sm/med |
12 |
12 |
$1K |
| A7038 |
Pos airway pressure filter |
126 |
117 |
$1K |
| A7003 |
Nebulizer administration set |
424 |
383 |
$683.44 |
| A7034 |
Nasal application device |
16 |
13 |
$611.76 |
| A7005 |
Nondisposable nebulizer set |
37 |
31 |
$499.14 |
| T4537 |
Reusable underpad bed size |
16 |
14 |
$184.41 |
| E0260 |
Hosp bed semi-electr w/ matt |
12 |
12 |
$141.10 |
| A4253 |
Blood glucose/reagent strips |
13 |
12 |
$57.36 |