| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S9999 |
Sales tax |
2,570 |
2,473 |
$31K |
| E0570 |
Nebulizer, with compressor |
1,634 |
1,516 |
$30K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
572 |
567 |
$27K |
| A4927 |
Gloves, non-sterile, per 100 |
840 |
830 |
$26K |
| T4541 |
Incontinence product, disposable underpad, large, each |
536 |
535 |
$23K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
241 |
238 |
$19K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
73 |
73 |
$13K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
66 |
66 |
$13K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
24 |
24 |
$4K |
| K0003 |
Lightweight wheelchair |
169 |
158 |
$2K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
71 |
69 |
$2K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
48 |
48 |
$1K |
| K0001 |
Standard wheelchair |
79 |
76 |
$509.83 |
| E0601 |
Continuous positive airway pressure (cpap) device |
45 |
45 |
$477.76 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
74 |
66 |
$361.65 |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
16 |
16 |
$275.20 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
33 |
33 |
$149.55 |
| E0156 |
Seat attachment, walker |
12 |
12 |
$89.99 |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
12 |
12 |
$56.26 |
| A5120 |
Skin barrier, wipes or swabs, each |
16 |
12 |
$42.88 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
13 |
13 |
$24.34 |
| G0008 |
Administration of influenza virus vaccine |
12 |
12 |
$0.00 |