| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4150 |
Ef complet w/intact nutrient |
1,296 |
1,270 |
$150K |
| A4927 |
Non-sterile gloves |
3,166 |
3,144 |
$99K |
| T4526 |
Adult size pull-on med |
1,215 |
1,208 |
$89K |
| A7030 |
Cpap full face mask |
924 |
922 |
$75K |
| T4541 |
Large disposable underpad |
1,196 |
1,177 |
$46K |
| T4523 |
Adult size brief/diaper lg |
355 |
352 |
$43K |
| A4604 |
Tubing with heating element |
1,407 |
1,402 |
$40K |
| T4535 |
Disposable liner/shield/pad |
608 |
602 |
$27K |
| E0601 |
Cont airway pressure device |
834 |
831 |
$27K |
| A7031 |
Replacement facemask interfa |
900 |
888 |
$26K |
| T4527 |
Adult size pull-on lg |
306 |
302 |
$25K |
| T4524 |
Adult size brief/diaper xl |
109 |
108 |
$15K |
| T4537 |
Reusable underpad bed size |
956 |
954 |
$15K |
| E1390 |
Oxygen concentrator |
369 |
368 |
$15K |
| T4528 |
Adult size pull-on xl |
130 |
130 |
$14K |
| A7035 |
Pos airway press headgear |
686 |
684 |
$11K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
123 |
122 |
$9K |
| E0260 |
Hosp bed semi-electr w/ matt |
260 |
259 |
$9K |
| A7038 |
Pos airway pressure filter |
1,612 |
1,579 |
$6K |
| K0001 |
Standard wheelchair |
413 |
413 |
$5K |
| T4522 |
Adult size brief/diaper med |
49 |
49 |
$5K |
| E0562 |
Humidifier heated used w pap |
217 |
217 |
$4K |
| B4152 |
Ef calorie dense>/=1.5kcal |
38 |
36 |
$4K |
| E0570 |
Nebulizer with compression |
24 |
24 |
$3K |
| A7034 |
Nasal application device |
64 |
64 |
$2K |
| A9901 |
Delivery/set up/dispensing |
667 |
663 |
$2K |
| K0195 |
Elevating whlchair leg rests |
140 |
140 |
$879.06 |
| A7032 |
Replacement nasal cushion |
25 |
25 |
$621.46 |
| K0738 |
Portable gas oxygen system |
24 |
24 |
$368.60 |
| A7003 |
Nebulizer administration set |
70 |
55 |
$165.33 |