| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0601 |
Continuous positive airway pressure (cpap) device |
1,105 |
1,041 |
$50K |
| A4554 |
Disposable underpads, all sizes |
746 |
558 |
$26K |
| T5999 |
Supply, not otherwise specified |
1,382 |
706 |
$19K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
47 |
41 |
$9K |
| X1922 |
|
26 |
24 |
$9K |
| K0001 |
Standard wheelchair |
347 |
305 |
$7K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
27 |
25 |
$3K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
436 |
419 |
$2K |
| A4927 |
Gloves, non-sterile, per 100 |
127 |
73 |
$2K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
199 |
191 |
$2K |
| A7035 |
Headgear used with positive airway pressure device |
17 |
12 |
$249.02 |