| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
20,031 |
19,788 |
$1.56M |
| E0603 |
Electric breast pump |
6,391 |
6,387 |
$925K |
| T4537 |
Reusable underpad bed size |
18,032 |
17,758 |
$559K |
| T4533 |
Youth size brief/diaper |
6,056 |
5,997 |
$507K |
| T4539 |
Reuse diaper/brief any size |
14,900 |
14,686 |
$465K |
| T4523 |
Adult size brief/diaper lg |
3,074 |
3,007 |
$404K |
| T4521 |
Adult size brief/diaper sm |
3,820 |
3,766 |
$317K |
| T4522 |
Adult size brief/diaper med |
2,954 |
2,879 |
$290K |
| T4524 |
Adult size brief/diaper xl |
1,802 |
1,783 |
$232K |
| T4540 |
Reusable underpad chair size |
13,130 |
12,871 |
$218K |
| T4530 |
Ped size brief/diaper lg |
2,653 |
2,634 |
$205K |
| A6539 |
Gc stocking waistlngth 18-30 |
674 |
665 |
$188K |
| K0823 |
Pwc gp 2 std cap chair |
816 |
809 |
$103K |
| E1392 |
Portable oxygen concentrator |
2,006 |
1,987 |
$101K |
| T4535 |
Disposable liner/shield/pad |
3,148 |
3,074 |
$96K |
| E0601 |
Cont airway pressure device |
2,260 |
2,239 |
$73K |
| E1390 |
Oxygen concentrator |
2,106 |
2,056 |
$72K |
| A4287 |
Disp col sto bag breast milk |
1,546 |
1,544 |
$64K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
1,473 |
1,435 |
$64K |
| A4402 |
Lubricant per ounce |
12,009 |
11,725 |
$56K |
| A4927 |
Non-sterile gloves |
14,752 |
14,408 |
$54K |
| K1005 |
Disp col sto bag breast milk |
1,194 |
1,193 |
$49K |
| E0445 |
Oximeter non-invasive |
351 |
349 |
$34K |
| E0570 |
Nebulizer with compression |
888 |
882 |
$27K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,470 |
1,456 |
$26K |
| A6402 |
Sterile gauze <= 16 sq in |
2,136 |
2,040 |
$24K |
| T4543 |
Adult disp brief/diap abv xl |
96 |
96 |
$22K |
| K0001 |
Standard wheelchair |
1,713 |
1,565 |
$15K |
| E0562 |
Humidifier heated used w pap |
413 |
408 |
$13K |
| A4385 |
Ost skn barrier sld ext wear |
327 |
306 |
$12K |
| E0602 |
Manual breast pump |
351 |
349 |
$11K |
| A6540 |
Gc stocking waistlngth 30-40 |
36 |
36 |
$11K |
| A4450 |
Non-waterproof tape |
1,039 |
1,000 |
$9K |
| E0630 |
Patient lift hydraulic |
281 |
280 |
$9K |
| E0261 |
Hosp bed semi-electr w/o mat |
158 |
156 |
$7K |
| A4362 |
Solid skin barrier |
206 |
201 |
$5K |
| A7034 |
Nasal application device |
232 |
230 |
$4K |
| A7035 |
Pos airway press headgear |
526 |
518 |
$4K |
| A4351 |
Straight tip urine catheter |
37 |
36 |
$4K |
| A4670 |
Automatic bp monitor, dial |
89 |
89 |
$3K |
| E0143 |
Walker folding wheeled w/o s |
119 |
119 |
$3K |
| K0195 |
Elevating whlchair leg rests |
1,321 |
1,299 |
$3K |
| E0990 |
Wheelchair elevating leg res |
228 |
215 |
$3K |
| A7037 |
Pos airway pressure tubing |
366 |
359 |
$2K |
| A6446 |
Conform band s w>=3" <5"/yd |
366 |
351 |
$2K |
| E0240 |
Bath/shower chair |
52 |
52 |
$2K |
| A4357 |
Bedside drainage bag |
157 |
142 |
$2K |
| A4217 |
Sterile water/saline, 500 ml |
823 |
793 |
$1K |
| A7038 |
Pos airway pressure filter |
722 |
710 |
$1K |
| E2611 |
Gen use back cush wdth <22in |
29 |
27 |
$1K |
| A4358 |
Urinary leg or abdomen bag |
136 |
124 |
$1K |
| A6216 |
Non-sterile gauze<=16 sq in |
426 |
406 |
$1K |
| A7003 |
Nebulizer administration set |
516 |
470 |
$917.63 |
| B4034 |
Enter feed supkit syr by day |
14 |
13 |
$762.78 |
| K0738 |
Portable gas oxygen system |
72 |
66 |
$524.06 |
| E0156 |
Walker seat attachment |
63 |
63 |
$421.23 |
| A7030 |
Cpap full face mask |
14 |
14 |
$402.13 |
| K0004 |
High strength ltwt whlchr |
39 |
37 |
$282.87 |
| A4456 |
Adhesive remover, wipes |
64 |
62 |
$199.72 |
| A5120 |
Skin barrier, wipe or swab |
62 |
61 |
$166.64 |
| E2601 |
Gen w/c cushion wdth < 22 in |
14 |
14 |
$96.05 |
| E0978 |
W/c acc,saf belt pelv strap |
12 |
12 |
$54.83 |
| A7013 |
Disposable compressor filter |
483 |
448 |
$52.73 |