| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
2,766 |
2,482 |
$348K |
| A4554 |
Disposable underpads |
6,439 |
5,643 |
$341K |
| E1390 |
Oxygen concentrator |
4,417 |
3,568 |
$260K |
| T4526 |
Adult size pull-on med |
2,078 |
1,774 |
$225K |
| T4528 |
Adult size pull-on xl |
1,517 |
1,362 |
$187K |
| T4534 |
Youth size pull-on |
1,182 |
1,072 |
$158K |
| A4927 |
Non-sterile gloves |
4,410 |
3,921 |
$156K |
| E0570 |
Nebulizer with compression |
3,999 |
3,218 |
$144K |
| B4150 |
Ef complet w/intact nutrient |
1,187 |
831 |
$115K |
| E0260 |
Hosp bed semi-electr w/ matt |
2,824 |
2,118 |
$62K |
| K0001 |
Standard wheelchair |
5,250 |
3,844 |
$52K |
| E0601 |
Cont airway pressure device |
1,105 |
910 |
$43K |
| E0431 |
Portable gaseous 02 |
3,635 |
2,950 |
$35K |
| T4525 |
Adult size pull-on sm |
272 |
218 |
$27K |
| A4335 |
Incontinence supply |
3,352 |
2,979 |
$24K |
| L0450 |
Tlso flex trunk/thor pre ots |
183 |
144 |
$21K |
| E0143 |
Walker folding wheeled w/o s |
598 |
470 |
$17K |
| T4544 |
Adlt disp und/pull on abv xl |
66 |
65 |
$11K |
| T4522 |
Adult size brief/diaper med |
79 |
63 |
$8K |
| T4523 |
Adult size brief/diaper lg |
62 |
51 |
$6K |
| A4627 |
Spacer bag/reservoir |
118 |
94 |
$5K |
| A4670 |
Automatic bp monitor, dial |
77 |
65 |
$4K |
| A7037 |
Pos airway pressure tubing |
263 |
237 |
$4K |
| A4253 |
Blood glucose/reagent strips |
508 |
420 |
$4K |
| A7035 |
Pos airway press headgear |
183 |
168 |
$3K |
| A7038 |
Pos airway pressure filter |
991 |
834 |
$3K |
| A7003 |
Nebulizer administration set |
1,263 |
1,058 |
$2K |
| E0630 |
Patient lift hydraulic |
163 |
112 |
$2K |
| A7030 |
Cpap full face mask |
25 |
25 |
$2K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
13 |
12 |
$2K |
| T4532 |
Ped size pull-on lg |
13 |
12 |
$2K |
| B4152 |
Ef calorie dense>/=1.5kcal |
25 |
12 |
$1K |
| E0156 |
Walker seat attachment |
195 |
162 |
$1K |
| E0163 |
Commode chair with fixed arm |
69 |
52 |
$1K |
| K0003 |
Lightweight wheelchair |
131 |
97 |
$939.89 |
| A7015 |
Aerosol mask used w nebulize |
361 |
287 |
$533.97 |
| K0195 |
Elevating whlchair leg rests |
30 |
24 |
$331.69 |
| E0149 |
Heavy duty wheeled walker |
14 |
12 |
$291.36 |
| A4259 |
Lancets per box |
250 |
192 |
$256.79 |