| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
6,587 |
6,155 |
$355K |
| T4527 |
Adult size pull-on lg |
1,965 |
1,851 |
$272K |
| T4528 |
Adult size pull-on xl |
1,853 |
1,772 |
$253K |
| T4526 |
Adult size pull-on med |
1,060 |
988 |
$132K |
| E0570 |
Nebulizer with compression |
2,049 |
1,536 |
$113K |
| E0601 |
Cont airway pressure device |
3,416 |
2,342 |
$97K |
| A7030 |
Cpap full face mask |
1,250 |
864 |
$60K |
| A4927 |
Non-sterile gloves |
2,295 |
2,137 |
$45K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
349 |
341 |
$31K |
| A7037 |
Pos airway pressure tubing |
2,084 |
1,415 |
$20K |
| A7005 |
Nondisposable nebulizer set |
846 |
720 |
$17K |
| A4627 |
Spacer bag/reservoir |
173 |
155 |
$7K |
| E0265 |
Hosp bed total electr w/ mat |
61 |
37 |
$6K |
| A7035 |
Pos airway press headgear |
572 |
424 |
$6K |
| A7038 |
Pos airway pressure filter |
2,566 |
1,740 |
$6K |
| A4335 |
Incontinence supply |
591 |
561 |
$4K |
| E0260 |
Hosp bed semi-electr w/ matt |
260 |
165 |
$4K |
| T4544 |
Adlt disp und/pull on abv xl |
19 |
12 |
$3K |
| K0001 |
Standard wheelchair |
373 |
246 |
$2K |
| A7015 |
Aerosol mask used w nebulize |
783 |
676 |
$1K |
| E1028 |
W/c manual swingaway |
74 |
48 |
$1K |
| E1390 |
Oxygen concentrator |
18 |
12 |
$674.54 |
| E0973 |
W/ch access det adj armrest |
56 |
25 |
$607.13 |