| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
1,599 |
1,160 |
$68K |
| E0570 |
Nebulizer, with compressor |
1,427 |
933 |
$24K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
899 |
536 |
$17K |
| A4927 |
Gloves, non-sterile, per 100 |
983 |
694 |
$15K |
| K0003 |
Lightweight wheelchair |
324 |
197 |
$8K |
| A4335 |
Incontinence supply; miscellaneous |
1,019 |
651 |
$5K |
| K0001 |
Standard wheelchair |
307 |
179 |
$4K |
| 0012A |
|
20 |
20 |
$1K |
| 0011A |
|
14 |
14 |
$496.94 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
28 |
24 |
$415.44 |
| 91301 |
|
44 |
36 |
$0.00 |