| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
1,771 |
1,575 |
$197K |
| T4542 |
Small disposable underpad |
4,812 |
4,462 |
$182K |
| T4528 |
Adult size pull-on xl |
1,330 |
1,237 |
$175K |
| T4526 |
Adult size pull-on med |
1,577 |
1,435 |
$161K |
| T4535 |
Disposable liner/shield/pad |
2,231 |
2,082 |
$132K |
| E1390 |
Oxygen concentrator |
5,572 |
4,378 |
$130K |
| B4150 |
Ef complet w/intact nutrient |
807 |
587 |
$60K |
| T4543 |
Adult disp brief/diap abv xl |
180 |
171 |
$47K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,164 |
941 |
$39K |
| E0431 |
Portable gaseous 02 |
3,558 |
2,941 |
$33K |
| A4927 |
Non-sterile gloves |
1,906 |
1,621 |
$25K |
| E0601 |
Cont airway pressure device |
1,032 |
867 |
$18K |
| E0570 |
Nebulizer with compression |
2,750 |
2,328 |
$11K |
| K0001 |
Standard wheelchair |
588 |
475 |
$9K |
| E0470 |
Rad w/o backup non-inv intfc |
94 |
79 |
$5K |
| A7030 |
Cpap full face mask |
164 |
136 |
$2K |
| E0562 |
Humidifier heated used w pap |
260 |
190 |
$2K |
| A7038 |
Pos airway pressure filter |
989 |
802 |
$2K |
| E0971 |
Wheelchair anti-tipping devi |
1,377 |
601 |
$2K |
| A4604 |
Tubing with heating element |
135 |
117 |
$1K |
| A7035 |
Pos airway press headgear |
114 |
95 |
$754.80 |
| A7031 |
Replacement facemask interfa |
39 |
36 |
$747.82 |
| A7037 |
Pos airway pressure tubing |
14 |
13 |
$87.71 |
| A7005 |
Nondisposable nebulizer set |
17 |
12 |
$87.00 |