| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1220 |
Whlchr special size/constrc |
184 |
136 |
$1.06M |
| B4035 |
Enteral feed supp pump per d |
2,524 |
1,587 |
$276K |
| E1390 |
Oxygen concentrator |
4,133 |
3,463 |
$214K |
| K0108 |
W/c component-accessory nos |
455 |
144 |
$203K |
| B9998 |
Enteral supp not otherwise c |
3,939 |
1,571 |
$201K |
| B4088 |
Gastro/jejuno tube, low-pro |
774 |
438 |
$77K |
| E0570 |
Nebulizer with compression |
3,694 |
2,935 |
$65K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,152 |
985 |
$40K |
| E0601 |
Cont airway pressure device |
805 |
716 |
$25K |
| T4522 |
Adult size brief/diaper med |
244 |
191 |
$22K |
| E1392 |
Portable oxygen concentrator |
1,738 |
1,405 |
$20K |
| A6402 |
Sterile gauze <= 16 sq in |
1,148 |
866 |
$16K |
| K0001 |
Standard wheelchair |
1,013 |
852 |
$11K |
| A4606 |
Oxygen probe used w oximeter |
33 |
24 |
$11K |
| E1028 |
W/c manual swingaway |
1,451 |
695 |
$11K |
| E0971 |
Wheelchair anti-tipping devi |
2,620 |
1,145 |
$10K |
| E0630 |
Patient lift hydraulic |
425 |
346 |
$8K |
| B4034 |
Enter feed supkit syr by day |
575 |
371 |
$7K |
| A4554 |
Disposable underpads |
131 |
88 |
$6K |
| K0823 |
Pwc gp 2 std cap chair |
103 |
101 |
$5K |
| A9999 |
Dme supply or accessory, nos |
1,155 |
242 |
$5K |
| E2607 |
Skin pro/pos wc cus wd <22in |
23 |
16 |
$3K |
| A7037 |
Pos airway pressure tubing |
473 |
252 |
$2K |
| E0431 |
Portable gaseous 02 |
183 |
174 |
$2K |
| A7000 |
Disposable canister for pump |
419 |
288 |
$2K |
| A7005 |
Nondisposable nebulizer set |
163 |
96 |
$2K |
| E0973 |
W/ch access det adj armrest |
27 |
12 |
$2K |
| A4628 |
Oropharyngeal suction cath |
33 |
24 |
$2K |
| T4523 |
Adult size brief/diaper lg |
16 |
12 |
$1K |
| A7038 |
Pos airway pressure filter |
777 |
215 |
$1K |
| A7034 |
Nasal application device |
62 |
38 |
$1K |
| A4217 |
Sterile water/saline, 500 ml |
52 |
25 |
$1K |
| E0562 |
Humidifier heated used w pap |
64 |
52 |
$1K |
| T4530 |
Ped size brief/diaper lg |
13 |
12 |
$937.08 |
| A7002 |
Tubing used w suction pump |
508 |
297 |
$906.17 |
| A7526 |
Tracheostomy tube collar |
27 |
12 |
$792.49 |
| A7035 |
Pos airway press headgear |
41 |
26 |
$161.51 |
| A7046 |
Repl water chamber, pap dev |
27 |
13 |
$120.69 |
| A7003 |
Nebulizer administration set |
81 |
70 |
$98.13 |
| A7039 |
Filter, non disposable w pap |
44 |
28 |
$59.50 |
| E0310 |
Rails bed side full length |
30 |
24 |
$0.00 |