| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
6,194 |
4,357 |
$220K |
| A4554 |
Disposable underpads |
5,695 |
4,498 |
$178K |
| X1939 |
|
2,870 |
2,384 |
$138K |
| T4527 |
Adult size pull-on lg |
2,482 |
1,957 |
$125K |
| T5999 |
Supply, nos |
13,236 |
9,264 |
$99K |
| T4528 |
Adult size pull-on xl |
1,482 |
1,192 |
$97K |
| E0601 |
Cont airway pressure device |
3,142 |
2,018 |
$70K |
| T4535 |
Disposable liner/shield/pad |
2,032 |
1,602 |
$56K |
| A7030 |
Cpap full face mask |
1,149 |
799 |
$46K |
| T4526 |
Adult size pull-on med |
943 |
803 |
$41K |
| E0431 |
Portable gaseous 02 |
4,465 |
3,123 |
$37K |
| A4927 |
Non-sterile gloves |
3,561 |
1,209 |
$32K |
| A7031 |
Replacement facemask interfa |
1,262 |
920 |
$27K |
| K0001 |
Standard wheelchair |
1,455 |
914 |
$24K |
| E0570 |
Nebulizer with compression |
1,965 |
1,211 |
$22K |
| A4604 |
Tubing with heating element |
1,810 |
1,198 |
$22K |
| T2028 |
Special supply, nos waiver |
421 |
207 |
$22K |
| X1922 |
|
359 |
120 |
$20K |
| E0260 |
Hosp bed semi-electr w/ matt |
369 |
194 |
$12K |
| E0466 |
Home vent non-invasive inter |
28 |
25 |
$12K |
| A7035 |
Pos airway press headgear |
1,148 |
791 |
$9K |
| A7038 |
Pos airway pressure filter |
2,664 |
1,823 |
$8K |
| A7034 |
Nasal application device |
429 |
289 |
$7K |
| E0562 |
Humidifier heated used w pap |
55 |
40 |
$4K |
| T4543 |
Adult disp brief/diap abv xl |
29 |
26 |
$3K |
| E0143 |
Walker folding wheeled w/o s |
158 |
102 |
$3K |
| E0470 |
Rad w/o backup non-inv intfc |
75 |
61 |
$3K |
| E1392 |
Portable oxygen concentrator |
342 |
297 |
$3K |
| A7046 |
Repl water chamber, pap dev |
546 |
394 |
$2K |
| A7033 |
Replacement nasal pillows |
115 |
88 |
$1K |
| K0195 |
Elevating whlchair leg rests |
208 |
154 |
$698.06 |
| K0002 |
Stnd hemi (low seat) whlchr |
34 |
13 |
$382.02 |
| A7032 |
Replacement nasal cushion |
14 |
12 |
$161.36 |