| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult size pull-on xl |
381 |
342 |
$48K |
| T4534 |
Youth size pull-on |
358 |
336 |
$36K |
| E0601 |
Cont airway pressure device |
491 |
438 |
$35K |
| T4535 |
Disposable liner/shield/pad |
496 |
438 |
$18K |
| A7030 |
Cpap full face mask |
78 |
70 |
$9K |
| A7031 |
Replacement facemask interfa |
194 |
186 |
$8K |
| T4526 |
Adult size pull-on med |
88 |
81 |
$8K |
| A4554 |
Disposable underpads |
312 |
260 |
$7K |
| A7035 |
Pos airway press headgear |
230 |
213 |
$5K |
| E0562 |
Humidifier heated used w pap |
158 |
143 |
$4K |
| T4527 |
Adult size pull-on lg |
45 |
37 |
$4K |
| A7038 |
Pos airway pressure filter |
810 |
758 |
$3K |
| E0570 |
Nebulizer with compression |
112 |
96 |
$2K |
| A7037 |
Pos airway pressure tubing |
286 |
265 |
$785.03 |
| A7034 |
Nasal application device |
15 |
14 |
$557.32 |
| A7046 |
Repl water chamber, pap dev |
43 |
36 |
$383.93 |
| A4927 |
Non-sterile gloves |
58 |
52 |
$233.00 |
| A4520 |
Incontinence garment anytype |
18 |
12 |
$214.74 |
| A4357 |
Bedside drainage bag |
55 |
50 |
$165.43 |
| A7039 |
Filter, non disposable w pap |
14 |
13 |
$129.77 |
| A4604 |
Tubing with heating element |
12 |
12 |
$41.28 |