| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
9,677 |
8,535 |
$1.08M |
| E1390 |
Oxygen concentrator |
18,451 |
16,780 |
$973K |
| E0601 |
Cont airway pressure device |
19,473 |
17,821 |
$926K |
| A7030 |
Cpap full face mask |
8,969 |
8,219 |
$654K |
| T4528 |
Adult size pull-on xl |
4,445 |
3,808 |
$590K |
| A4604 |
Tubing with heating element |
17,838 |
16,249 |
$503K |
| T4526 |
Adult size pull-on med |
4,982 |
4,465 |
$468K |
| A7031 |
Replacement facemask interfa |
13,933 |
12,801 |
$467K |
| T4534 |
Youth size pull-on |
1,727 |
1,539 |
$386K |
| E0562 |
Humidifier heated used w pap |
4,724 |
4,057 |
$385K |
| A4222 |
Infusion supplies with pump |
4,667 |
2,025 |
$379K |
| T4535 |
Disposable liner/shield/pad |
6,139 |
5,960 |
$378K |
| E0470 |
Rad w/o backup non-inv intfc |
3,005 |
2,774 |
$304K |
| S9999 |
Sales tax |
31,268 |
27,246 |
$303K |
| A4351 |
Straight tip urine catheter |
1,089 |
926 |
$290K |
| T4541 |
Large disposable underpad |
5,402 |
5,306 |
$283K |
| A4927 |
Non-sterile gloves |
7,455 |
7,265 |
$269K |
| A7034 |
Nasal application device |
5,887 |
5,378 |
$261K |
| T4537 |
Reusable underpad bed size |
5,744 |
5,593 |
$253K |
| A7032 |
Replacement nasal cushion |
6,200 |
5,591 |
$233K |
| E0570 |
Nebulizer with compression |
8,811 |
8,060 |
$205K |
| A7035 |
Pos airway press headgear |
12,304 |
11,214 |
$178K |
| A4385 |
Ost skn barrier sld ext wear |
1,577 |
1,351 |
$157K |
| A7038 |
Pos airway pressure filter |
27,628 |
25,155 |
$130K |
| T4544 |
Adlt disp und/pull on abv xl |
486 |
449 |
$123K |
| E0781 |
External ambulatory infus pu |
929 |
775 |
$117K |
| E0431 |
Portable gaseous 02 |
8,703 |
7,927 |
$107K |
| E0260 |
Hosp bed semi-electr w/ matt |
3,094 |
2,913 |
$102K |
| A4409 |
Ost skn barr convex <=4 sq i |
1,199 |
1,023 |
$93K |
| E1161 |
Manual adult wc w tiltinspac |
87 |
76 |
$81K |
| E0471 |
Rad w/backup non inv intrfc |
324 |
308 |
$80K |
| K0738 |
Portable gas oxygen system |
2,762 |
2,573 |
$59K |
| A7033 |
Replacement nasal pillows |
2,162 |
1,994 |
$59K |
| A4221 |
Supp non-insulin inf cath/wk |
3,993 |
1,757 |
$54K |
| K0003 |
Lightweight wheelchair |
2,085 |
1,962 |
$53K |
| E1392 |
Portable oxygen concentrator |
2,841 |
2,480 |
$50K |
| A4223 |
Infusion supplies w/o pump |
592 |
217 |
$49K |
| E0143 |
Walker folding wheeled w/o s |
1,445 |
1,315 |
$49K |
| A7046 |
Repl water chamber, pap dev |
5,059 |
4,716 |
$45K |
| A4425 |
Ost pch drain for barrier fl |
756 |
619 |
$45K |
| T4525 |
Adult size pull-on sm |
297 |
269 |
$42K |
| B4035 |
Enteral feed supp pump per d |
604 |
356 |
$41K |
| A6530 |
Compression stocking bk18-30 |
525 |
443 |
$33K |
| A7005 |
Nondisposable nebulizer set |
1,988 |
1,845 |
$33K |
| A7039 |
Filter, non disposable w pap |
4,693 |
4,344 |
$25K |
| E0466 |
Home vent non-invasive inter |
69 |
60 |
$21K |
| E0443 |
Portable 02 contents, gas |
1,326 |
1,228 |
$20K |
| K0001 |
Standard wheelchair |
714 |
669 |
$18K |
| A4362 |
Solid skin barrier |
157 |
134 |
$16K |
| A7037 |
Pos airway pressure tubing |
915 |
836 |
$11K |
| A5063 |
Drain ostomy pouch w/flange |
272 |
224 |
$10K |
| E0973 |
W/ch access det adj armrest |
270 |
184 |
$9K |
| K0108 |
W/c component-accessory nos |
90 |
65 |
$9K |
| E0971 |
Wheelchair anti-tipping devi |
328 |
274 |
$9K |
| T4532 |
Ped size pull-on lg |
37 |
37 |
$8K |
| A5120 |
Skin barrier, wipe or swab |
1,259 |
1,034 |
$8K |
| T4524 |
Adult size brief/diaper xl |
42 |
41 |
$8K |
| T4523 |
Adult size brief/diaper lg |
51 |
50 |
$7K |
| A4406 |
Pectin based ostomy paste |
373 |
314 |
$7K |
| E1028 |
W/c manual swingaway |
86 |
66 |
$7K |
| A4357 |
Bedside drainage bag |
900 |
737 |
$6K |
| E0149 |
Heavy duty wheeled walker |
505 |
468 |
$6K |
| K0739 |
Repair/svc dme non-oxygen eq |
370 |
151 |
$4K |
| B4152 |
Ef calorie dense>/=1.5kcal |
128 |
77 |
$4K |
| J9190 |
Fluorouracil injection |
833 |
405 |
$4K |
| B4034 |
Enter feed supkit syr by day |
72 |
52 |
$3K |
| A7003 |
Nebulizer administration set |
1,118 |
1,049 |
$3K |
| E0156 |
Walker seat attachment |
359 |
320 |
$3K |
| E0955 |
Cushioned headrest |
26 |
25 |
$2K |
| K0195 |
Elevating whlchair leg rests |
457 |
409 |
$2K |
| T4522 |
Adult size brief/diaper med |
15 |
15 |
$2K |
| A7036 |
Pos airway press chinstrap |
199 |
191 |
$2K |
| E2611 |
Gen use back cush wdth <22in |
14 |
12 |
$2K |
| E0951 |
Loop heel |
114 |
91 |
$1K |
| A7015 |
Aerosol mask used w nebulize |
726 |
702 |
$1K |
| A4253 |
Blood glucose/reagent strips |
104 |
78 |
$900.86 |
| A4367 |
Ostomy belt |
88 |
73 |
$860.07 |
| A4456 |
Adhesive remover, wipes |
52 |
42 |
$439.78 |
| A4306 |
Drug delivery system <=50 ml |
168 |
80 |
$436.05 |
| E0163 |
Commode chair with fixed arm |
20 |
12 |
$355.37 |
| A7004 |
Disposable nebulizer sml vol |
191 |
167 |
$243.96 |
| A4371 |
Skin barrier powder per oz |
69 |
54 |
$216.72 |
| A4358 |
Urinary leg or abdomen bag |
30 |
24 |
$137.80 |
| A4213 |
20+ cc syringe only |
15 |
12 |
$96.32 |
| A6402 |
Sterile gauze <= 16 sq in |
15 |
12 |
$96.02 |
| A4930 |
Sterile, gloves per pair |
35 |
26 |
$31.70 |
| A4245 |
Alcohol wipes per box |
22 |
15 |
$4.98 |
| A4450 |
Non-waterproof tape |
13 |
13 |
$3.86 |
| A9270 |
Non-covered item or service |
12 |
12 |
$0.00 |