| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
64 |
57 |
$392K |
| T4543 |
Adult disp brief/diap abv xl |
1,151 |
1,139 |
$339K |
| T4524 |
Adult size brief/diaper xl |
690 |
685 |
$103K |
| E0570 |
Nebulizer with compression |
973 |
917 |
$61K |
| E0601 |
Cont airway pressure device |
396 |
386 |
$29K |
| A4927 |
Non-sterile gloves |
1,495 |
1,463 |
$24K |
| E1236 |
Folding ped wc adjustable |
133 |
133 |
$24K |
| T4523 |
Adult size brief/diaper lg |
126 |
125 |
$18K |
| T4522 |
Adult size brief/diaper med |
144 |
137 |
$16K |
| E1028 |
W/c manual swingaway |
175 |
153 |
$10K |
| K0001 |
Standard wheelchair |
241 |
234 |
$6K |
| T4541 |
Large disposable underpad |
136 |
133 |
$3K |
| E1161 |
Manual adult wc w tiltinspac |
38 |
38 |
$2K |
| A7035 |
Pos airway press headgear |
13 |
13 |
$339.53 |
| K0739 |
Repair/svc dme non-oxygen eq |
29 |
29 |
$265.11 |
| E0955 |
Cushioned headrest |
41 |
41 |
$143.51 |
| K0195 |
Elevating whlchair leg rests |
25 |
24 |
$48.16 |