| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2028 |
Specialized supply, not otherwise specified, waiver |
917 |
881 |
$127K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,681 |
2,254 |
$126K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
596 |
515 |
$73K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
809 |
745 |
$51K |
| A4927 |
Gloves, non-sterile, per 100 |
1,065 |
891 |
$27K |
| E0570 |
Nebulizer, with compressor |
1,178 |
963 |
$26K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,184 |
1,850 |
$21K |
| K0001 |
Standard wheelchair |
120 |
120 |
$677.60 |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
15 |
12 |
$483.93 |
| K0003 |
Lightweight wheelchair |
32 |
29 |
$253.77 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
16 |
12 |
$214.59 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
15 |
12 |
$198.74 |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
21 |
13 |
$88.36 |