| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
2,726 |
2,715 |
$320K |
| T4541 |
Large disposable underpad |
3,795 |
3,653 |
$141K |
| T4527 |
Adult size pull-on lg |
2,418 |
2,289 |
$134K |
| K0001 |
Standard wheelchair |
4,755 |
4,726 |
$124K |
| E0601 |
Cont airway pressure device |
1,252 |
1,252 |
$116K |
| T4535 |
Disposable liner/shield/pad |
1,966 |
1,934 |
$95K |
| E0443 |
Portable 02 contents, gas |
1,840 |
1,818 |
$93K |
| T4526 |
Adult size pull-on med |
1,941 |
1,876 |
$89K |
| E0295 |
Hosp bed semi-elect w/o matt |
1,011 |
1,010 |
$74K |
| T4528 |
Adult size pull-on xl |
1,129 |
1,104 |
$71K |
| E0470 |
Rad w/o backup non-inv intfc |
100 |
100 |
$47K |
| A7034 |
Nasal application device |
774 |
774 |
$46K |
| E0431 |
Portable gaseous 02 |
2,274 |
2,257 |
$46K |
| E0562 |
Humidifier heated used w pap |
884 |
884 |
$44K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,473 |
1,468 |
$39K |
| A7038 |
Pos airway pressure filter |
4,255 |
4,233 |
$29K |
| A7035 |
Pos airway press headgear |
1,511 |
1,510 |
$29K |
| A7037 |
Pos airway pressure tubing |
1,536 |
1,536 |
$27K |
| K0006 |
Heavy duty wheelchair |
305 |
298 |
$22K |
| E0570 |
Nebulizer with compression |
805 |
804 |
$16K |
| K0195 |
Elevating whlchair leg rests |
1,013 |
1,009 |
$14K |
| T4522 |
Adult size brief/diaper med |
245 |
245 |
$13K |
| E1399 |
Durable medical equipment mi |
218 |
138 |
$12K |
| E0143 |
Walker folding wheeled w/o s |
222 |
220 |
$12K |
| E0305 |
Rails bed side half length |
800 |
796 |
$10K |
| A7030 |
Cpap full face mask |
146 |
146 |
$10K |
| A7039 |
Filter, non disposable w pap |
1,274 |
1,274 |
$9K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
484 |
477 |
$8K |
| E0971 |
Wheelchair anti-tipping devi |
1,069 |
803 |
$8K |
| A7032 |
Replacement nasal cushion |
321 |
287 |
$8K |
| E0272 |
Mattress foam rubber |
557 |
545 |
$7K |
| K0003 |
Lightweight wheelchair |
148 |
148 |
$6K |
| E0265 |
Hosp bed total electr w/ mat |
25 |
25 |
$4K |
| E0181 |
Press pad alternating w/ pum |
250 |
250 |
$3K |
| E0730 |
Tens four lead |
133 |
133 |
$3K |
| A7031 |
Replacement facemask interfa |
109 |
85 |
$3K |
| A6549 |
Grad com garm noc day use |
56 |
36 |
$3K |
| K0739 |
Repair/svc dme non-oxygen eq |
41 |
36 |
$2K |
| E0973 |
W/ch access det adj armrest |
63 |
42 |
$2K |
| E0627 |
Seat lift mech, electric any |
120 |
114 |
$2K |
| E0245 |
Tub stool or bench |
39 |
39 |
$2K |
| E1392 |
Portable oxygen concentrator |
12 |
12 |
$2K |
| T4523 |
Adult size brief/diaper lg |
38 |
38 |
$1K |
| K0007 |
Extra heavy duty wheelchair |
68 |
68 |
$1K |
| E0630 |
Patient lift hydraulic |
49 |
49 |
$837.84 |
| E0978 |
W/c acc,saf belt pelv strap |
186 |
186 |
$812.58 |
| A7046 |
Repl water chamber, pap dev |
74 |
74 |
$729.31 |
| E0951 |
Loop heel |
321 |
191 |
$501.71 |
| E0156 |
Walker seat attachment |
37 |
36 |
$436.18 |
| A7033 |
Replacement nasal pillows |
58 |
53 |
$314.83 |
| A4402 |
Lubricant per ounce |
12 |
12 |
$12.70 |
| E0990 |
Wheelchair elevating leg res |
114 |
99 |
$0.00 |
| E2208 |
Cylinder tank carrier |
95 |
94 |
$0.00 |