| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0603 |
Electric breast pump |
127,712 |
114,692 |
$22.39M |
| A6530 |
Compression stocking bk18-30 |
24,520 |
22,234 |
$2.02M |
| T4532 |
Ped size pull-on lg |
17,439 |
16,675 |
$1.81M |
| L0621 |
Sio flex pelvic/sacr pre ots |
36,015 |
31,911 |
$1.75M |
| K1005 |
Disp col sto bag breast milk |
17,034 |
15,404 |
$1.17M |
| A4287 |
Disp col sto bag breast milk |
13,876 |
13,058 |
$1.14M |
| T4535 |
Disposable liner/shield/pad |
23,199 |
20,828 |
$1.12M |
| T4533 |
Youth size brief/diaper |
12,747 |
11,931 |
$1.06M |
| L2630 |
Pelvic control band & belt u |
7,651 |
7,161 |
$1.02M |
| A4353 |
Intermittent urinary cath |
2,590 |
1,742 |
$884K |
| T4527 |
Adult size pull-on lg |
9,923 |
8,868 |
$704K |
| T4541 |
Large disposable underpad |
21,385 |
18,183 |
$694K |
| A6212 |
Foam drg <=16 sq in w/border |
4,210 |
4,032 |
$581K |
| T4526 |
Adult size pull-on med |
8,558 |
7,573 |
$569K |
| T4528 |
Adult size pull-on xl |
6,893 |
6,283 |
$559K |
| T4544 |
Adlt disp und/pull on abv xl |
5,480 |
4,763 |
$509K |
| T4534 |
Youth size pull-on |
5,869 |
5,629 |
$458K |
| A4467 |
Belt strap sleev grmnt cover |
6,505 |
6,154 |
$380K |
| A4554 |
Disposable underpads |
14,314 |
13,555 |
$322K |
| L0641 |
Lo rig pos pnl l1-l5 pre ots |
5,128 |
4,923 |
$240K |
| T4530 |
Ped size brief/diaper lg |
2,714 |
2,529 |
$236K |
| A4351 |
Straight tip urine catheter |
2,656 |
1,950 |
$216K |
| T4525 |
Adult size pull-on sm |
1,819 |
1,689 |
$131K |
| E0570 |
Nebulizer with compression |
14,670 |
13,426 |
$122K |
| A4239 |
Non-adju cgm supply allow |
1,666 |
1,141 |
$100K |
| A6245 |
Hydrogel drg <= 16 in w/bdr |
3,754 |
3,606 |
$99K |
| E0601 |
Cont airway pressure device |
5,709 |
4,291 |
$79K |
| T4531 |
Ped size pull-on sm/med |
878 |
830 |
$78K |
| A7030 |
Cpap full face mask |
2,373 |
1,704 |
$71K |
| K0553 |
Ther cgm supply allowance |
488 |
347 |
$45K |
| A4604 |
Tubing with heating element |
2,732 |
2,071 |
$42K |
| E0562 |
Humidifier heated used w pap |
2,175 |
1,712 |
$39K |
| A7034 |
Nasal application device |
1,640 |
1,246 |
$36K |
| A7031 |
Replacement facemask interfa |
2,633 |
1,849 |
$34K |
| E1390 |
Oxygen concentrator |
1,678 |
1,399 |
$28K |
| A7005 |
Nondisposable nebulizer set |
2,151 |
2,006 |
$24K |
| A7032 |
Replacement nasal cushion |
1,353 |
1,004 |
$22K |
| A4927 |
Non-sterile gloves |
1,800 |
1,776 |
$22K |
| A7035 |
Pos airway press headgear |
2,586 |
1,968 |
$19K |
| E0470 |
Rad w/o backup non-inv intfc |
590 |
417 |
$18K |
| T4522 |
Adult size brief/diaper med |
224 |
199 |
$14K |
| E2402 |
Neg press wound therapy pump |
157 |
130 |
$10K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
87 |
83 |
$10K |
| A7038 |
Pos airway pressure filter |
4,888 |
3,603 |
$9K |
| T4543 |
Adult disp brief/diap abv xl |
95 |
78 |
$8K |
| T4524 |
Adult size brief/diaper xl |
104 |
92 |
$8K |
| A7045 |
Repl exhalation port for pap |
2,360 |
1,789 |
$8K |
| A7046 |
Repl water chamber, pap dev |
2,003 |
1,455 |
$7K |
| A7037 |
Pos airway pressure tubing |
1,384 |
996 |
$7K |
| A4357 |
Bedside drainage bag |
1,031 |
743 |
$5K |
| A6250 |
Skin seal protect moisturizr |
126 |
113 |
$5K |
| A4332 |
Lube sterile packet |
790 |
593 |
$5K |
| T4523 |
Adult size brief/diaper lg |
39 |
37 |
$3K |
| A4344 |
Cath indw foley 2 way silicn |
86 |
63 |
$3K |
| A4285 |
Replcmnt breast pump bottle |
280 |
257 |
$2K |
| A4217 |
Sterile water/saline, 500 ml |
66 |
52 |
$2K |
| A4284 |
Replcmnt breast pump shield |
523 |
278 |
$2K |
| A4281 |
Replacement breastpump tube |
520 |
277 |
$2K |
| A7015 |
Aerosol mask used w nebulize |
1,583 |
1,537 |
$2K |
| A7033 |
Replacement nasal pillows |
97 |
64 |
$1K |
| A4283 |
Replacement breastpump cap |
310 |
278 |
$1K |
| A4282 |
Replacement breastpump adpt |
520 |
277 |
$885.00 |
| A7013 |
Disposable compressor filter |
2,082 |
1,979 |
$881.63 |
| A6550 |
Neg pres wound ther drsg set |
76 |
40 |
$675.96 |
| E0431 |
Portable gaseous 02 |
232 |
207 |
$629.29 |
| A7039 |
Filter, non disposable w pap |
246 |
176 |
$619.59 |
| A7036 |
Pos airway press chinstrap |
126 |
91 |
$568.95 |
| A4310 |
Insert tray w/o bag/cath |
47 |
24 |
$531.02 |
| A4520 |
Incontinence garment anytype |
17 |
13 |
$353.85 |
| 94660 |
|
13 |
12 |
$299.95 |
| A4286 |
Replcmnt breastpump lok ring |
513 |
276 |
$173.00 |
| A7000 |
Disposable canister for pump |
73 |
37 |
$140.07 |
| A4617 |
Mouth piece |
152 |
149 |
$70.64 |
| E1353 |
Oxygen supplies regulator |
38 |
33 |
$11.97 |
| A4322 |
Irrigation syringe |
12 |
12 |
$5.80 |