| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
3,181 |
2,975 |
$209K |
| T4523 |
Adult size brief/diaper lg |
1,175 |
1,109 |
$142K |
| T4521 |
Adult size brief/diaper sm |
1,175 |
1,136 |
$119K |
| T4522 |
Adult size brief/diaper med |
936 |
902 |
$97K |
| T4537 |
Reusable underpad bed size |
1,236 |
1,161 |
$38K |
| E0601 |
Cont airway pressure device |
148 |
144 |
$27K |
| T4533 |
Youth size brief/diaper |
363 |
346 |
$27K |
| T4535 |
Disposable liner/shield/pad |
621 |
569 |
$19K |
| T4524 |
Adult size brief/diaper xl |
124 |
123 |
$19K |
| E1390 |
Oxygen concentrator |
271 |
267 |
$15K |
| A4927 |
Non-sterile gloves |
2,302 |
2,115 |
$9K |
| K0003 |
Lightweight wheelchair |
305 |
304 |
$4K |
| E0562 |
Humidifier heated used w pap |
31 |
31 |
$3K |
| K0001 |
Standard wheelchair |
200 |
200 |
$3K |
| E0143 |
Walker folding wheeled w/o s |
61 |
61 |
$3K |
| E0260 |
Hosp bed semi-electr w/ matt |
305 |
305 |
$2K |
| A7030 |
Cpap full face mask |
21 |
21 |
$2K |
| A4239 |
Non-adju cgm supply allow |
15 |
12 |
$934.54 |
| A7031 |
Replacement facemask interfa |
20 |
20 |
$842.08 |
| A7035 |
Pos airway press headgear |
72 |
72 |
$592.92 |
| K0195 |
Elevating whlchair leg rests |
466 |
465 |
$412.82 |
| A7034 |
Nasal application device |
12 |
12 |
$402.00 |
| A7037 |
Pos airway pressure tubing |
55 |
55 |
$397.48 |
| A7038 |
Pos airway pressure filter |
197 |
197 |
$365.31 |
| A4402 |
Lubricant per ounce |
43 |
36 |
$130.32 |
| A7036 |
Pos airway press chinstrap |
12 |
12 |
$98.92 |
| A7039 |
Filter, non disposable w pap |
32 |
32 |
$24.36 |