| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4542 |
Small disposable underpad |
4,395 |
3,382 |
$155K |
| T4528 |
Adult size pull-on xl |
923 |
650 |
$102K |
| T4527 |
Adult size pull-on lg |
973 |
697 |
$100K |
| T4543 |
Adult disp brief/diap abv xl |
385 |
291 |
$96K |
| T4535 |
Disposable liner/shield/pad |
1,842 |
1,370 |
$89K |
| E1390 |
Oxygen concentrator |
2,498 |
1,694 |
$59K |
| T4526 |
Adult size pull-on med |
807 |
563 |
$57K |
| E0601 |
Cont airway pressure device |
1,441 |
1,126 |
$29K |
| A4927 |
Non-sterile gloves |
1,312 |
959 |
$17K |
| E0431 |
Portable gaseous 02 |
1,386 |
977 |
$15K |
| K0001 |
Standard wheelchair |
532 |
387 |
$10K |
| E0570 |
Nebulizer with compression |
1,111 |
823 |
$7K |
| E0562 |
Humidifier heated used w pap |
818 |
608 |
$7K |
| E0260 |
Hosp bed semi-electr w/ matt |
255 |
205 |
$3K |
| B4150 |
Ef complet w/intact nutrient |
32 |
24 |
$3K |
| T4537 |
Reusable underpad bed size |
23 |
20 |
$3K |
| A4604 |
Tubing with heating element |
162 |
117 |
$1K |
| A7030 |
Cpap full face mask |
48 |
30 |
$922.95 |
| A7038 |
Pos airway pressure filter |
508 |
349 |
$674.72 |
| E0971 |
Wheelchair anti-tipping devi |
699 |
274 |
$583.12 |
| A7035 |
Pos airway press headgear |
79 |
63 |
$446.90 |