| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
3,434 |
3,418 |
$239K |
| T4535 |
Disposable liner/shield/pad |
3,847 |
3,796 |
$238K |
| T4528 |
Adult size pull-on xl |
1,414 |
1,396 |
$182K |
| T4527 |
Adult size pull-on lg |
1,542 |
1,526 |
$158K |
| T4541 |
Large disposable underpad |
3,484 |
3,470 |
$146K |
| T4526 |
Adult size pull-on med |
815 |
807 |
$75K |
| E0570 |
Nebulizer with compression |
1,824 |
1,817 |
$59K |
| K0001 |
Standard wheelchair |
2,056 |
2,045 |
$46K |
| E0431 |
Portable gaseous 02 |
2,646 |
2,636 |
$29K |
| E0260 |
Hosp bed semi-electr w/ matt |
900 |
899 |
$23K |
| S5161 |
Emer rspns sys serv permonth |
507 |
506 |
$18K |
| T1999 |
Noc retail items andsupplies |
59 |
59 |
$14K |
| E0601 |
Cont airway pressure device |
308 |
308 |
$9K |
| A4927 |
Non-sterile gloves |
431 |
408 |
$8K |
| A7030 |
Cpap full face mask |
94 |
94 |
$6K |
| E0562 |
Humidifier heated used w pap |
227 |
226 |
$5K |
| A4335 |
Incontinence supply |
332 |
332 |
$5K |
| A7035 |
Pos airway press headgear |
107 |
107 |
$2K |
| A7005 |
Nondisposable nebulizer set |
66 |
66 |
$1K |
| A7037 |
Pos airway pressure tubing |
126 |
126 |
$1K |
| A7038 |
Pos airway pressure filter |
280 |
280 |
$820.63 |
| E0143 |
Walker folding wheeled w/o s |
12 |
12 |
$466.56 |
| A7031 |
Replacement facemask interfa |
54 |
54 |
$294.97 |
| A7013 |
Disposable compressor filter |
130 |
130 |
$281.90 |
| A7003 |
Nebulizer administration set |
28 |
28 |
$52.12 |