| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/pad |
8,117 |
7,887 |
$443K |
| E1390 |
Oxygen concentrator |
7,415 |
7,407 |
$407K |
| T4527 |
Adult size pull-on lg |
3,382 |
3,315 |
$340K |
| T4526 |
Adult size pull-on med |
2,875 |
2,766 |
$264K |
| T4528 |
Adult size pull-on xl |
1,891 |
1,845 |
$215K |
| E0570 |
Nebulizer with compression |
4,016 |
4,005 |
$182K |
| T4541 |
Large disposable underpad |
3,823 |
3,708 |
$144K |
| T4543 |
Adult disp brief/diap abv xl |
666 |
643 |
$110K |
| T1999 |
Noc retail items andsupplies |
548 |
514 |
$102K |
| E0431 |
Portable gaseous 02 |
5,595 |
5,591 |
$56K |
| A4927 |
Non-sterile gloves |
1,880 |
1,806 |
$51K |
| K0001 |
Standard wheelchair |
2,363 |
2,354 |
$48K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,780 |
1,766 |
$48K |
| T4540 |
Reusable underpad chair size |
331 |
324 |
$21K |
| E0443 |
Portable 02 contents, gas |
1,080 |
1,080 |
$16K |
| T4542 |
Small disposable underpad |
457 |
440 |
$15K |
| E0601 |
Cont airway pressure device |
145 |
141 |
$9K |
| A7003 |
Nebulizer administration set |
2,453 |
2,452 |
$9K |
| K0823 |
Pwc gp 2 std cap chair |
167 |
167 |
$8K |
| B4150 |
Ef complet w/intact nutrient |
72 |
67 |
$8K |
| T4544 |
Adlt disp und/pull on abv xl |
25 |
24 |
$5K |
| E0562 |
Humidifier heated used w pap |
115 |
109 |
$3K |
| A7015 |
Aerosol mask used w nebulize |
1,754 |
1,754 |
$3K |
| A7013 |
Disposable compressor filter |
934 |
934 |
$3K |
| A7014 |
Compressor nondispos filter |
713 |
713 |
$2K |
| E1392 |
Portable oxygen concentrator |
262 |
261 |
$2K |
| A7037 |
Pos airway pressure tubing |
239 |
239 |
$2K |
| A7038 |
Pos airway pressure filter |
1,019 |
1,013 |
$1K |
| A7035 |
Pos airway press headgear |
98 |
98 |
$920.51 |
| A7030 |
Cpap full face mask |
14 |
14 |
$555.80 |
| A7034 |
Nasal application device |
12 |
12 |
$187.42 |