| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4525 |
Adult size pull-on sm |
95 |
95 |
$51.66 |
| T4541 |
Large disposable underpad |
497 |
491 |
$0.00 |
| E0601 |
Cont airway pressure device |
326 |
326 |
$0.00 |
| E1390 |
Oxygen concentrator |
480 |
480 |
$0.00 |
| T4527 |
Adult size pull-on lg |
160 |
160 |
$0.00 |
| T4526 |
Adult size pull-on med |
160 |
158 |
$0.00 |
| A4927 |
Non-sterile gloves |
71 |
66 |
$0.00 |
| A7035 |
Pos airway press headgear |
61 |
61 |
$0.00 |
| E0295 |
Hosp bed semi-elect w/o matt |
208 |
208 |
$0.00 |
| A6250 |
Skin seal protect moisturizr |
24 |
24 |
$0.00 |
| K0195 |
Elevating whlchair leg rests |
150 |
150 |
$0.00 |
| T4528 |
Adult size pull-on xl |
117 |
117 |
$0.00 |
| T4533 |
Youth size brief/diaper |
13 |
12 |
$0.00 |
| A7003 |
Nebulizer administration set |
15 |
15 |
$0.00 |
| T4522 |
Adult size brief/diaper med |
38 |
38 |
$0.00 |
| E0570 |
Nebulizer with compression |
787 |
782 |
$0.00 |
| A7015 |
Aerosol mask used w nebulize |
32 |
27 |
$0.00 |
| E0562 |
Humidifier heated used w pap |
507 |
507 |
$0.00 |
| T4534 |
Youth size pull-on |
82 |
82 |
$0.00 |
| A7037 |
Pos airway pressure tubing |
26 |
24 |
$0.00 |
| E0470 |
Rad w/o backup non-inv intfc |
111 |
111 |
$0.00 |
| E0431 |
Portable gaseous 02 |
400 |
391 |
$0.00 |
| K0001 |
Standard wheelchair |
544 |
544 |
$0.00 |
| E1392 |
Portable oxygen concentrator |
24 |
24 |
$0.00 |
| T4535 |
Disposable liner/shield/pad |
269 |
257 |
$0.00 |
| E0271 |
Mattress innerspring |
126 |
124 |
$0.00 |
| T4523 |
Adult size brief/diaper lg |
39 |
39 |
$0.00 |
| A5120 |
Skin barrier, wipe or swab |
40 |
38 |
$0.00 |
| E0305 |
Rails bed side half length |
212 |
210 |
$0.00 |
| A4335 |
Incontinence supply |
26 |
26 |
$0.00 |
| E0630 |
Patient lift hydraulic |
24 |
24 |
$0.00 |
| E0143 |
Walker folding wheeled w/o s |
15 |
15 |
$0.00 |
| E0603 |
Electric breast pump |
29 |
29 |
$0.00 |