| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0601 |
Cont airway pressure device |
1,282 |
1,279 |
$72K |
| E0443 |
Portable 02 contents, gas |
528 |
528 |
$47K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
171 |
157 |
$32K |
| E0431 |
Portable gaseous 02 |
566 |
566 |
$27K |
| K0001 |
Standard wheelchair |
800 |
800 |
$26K |
| E1390 |
Oxygen concentrator |
630 |
629 |
$25K |
| E0570 |
Nebulizer with compression |
281 |
280 |
$23K |
| E0470 |
Rad w/o backup non-inv intfc |
135 |
135 |
$16K |
| E0562 |
Humidifier heated used w pap |
1,511 |
1,508 |
$8K |
| T4541 |
Large disposable underpad |
1,524 |
1,523 |
$8K |
| T4535 |
Disposable liner/shield/pad |
852 |
834 |
$7K |
| T4527 |
Adult size pull-on lg |
271 |
269 |
$7K |
| T4522 |
Adult size brief/diaper med |
181 |
178 |
$5K |
| E0143 |
Walker folding wheeled w/o s |
82 |
82 |
$5K |
| T4526 |
Adult size pull-on med |
321 |
321 |
$3K |
| T4534 |
Youth size pull-on |
97 |
97 |
$3K |
| T4523 |
Adult size brief/diaper lg |
37 |
37 |
$2K |
| A6402 |
Sterile gauze <= 16 sq in |
56 |
55 |
$2K |
| A4927 |
Non-sterile gloves |
13 |
12 |
$817.49 |
| T4530 |
Ped size brief/diaper lg |
37 |
37 |
$756.36 |
| K0195 |
Elevating whlchair leg rests |
24 |
24 |
$204.88 |
| A4322 |
Irrigation syringe |
13 |
12 |
$117.15 |
| A7003 |
Nebulizer administration set |
15 |
15 |
$0.00 |