| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Ft insert ucb berkeley shell |
2,099 |
1,039 |
$411K |
| E0466 |
Home vent non-invasive inter |
664 |
644 |
$375K |
| E1390 |
Oxygen concentrator |
3,125 |
3,060 |
$336K |
| E0603 |
Electric breast pump |
2,352 |
2,323 |
$319K |
| A4554 |
Disposable underpads |
3,404 |
3,293 |
$157K |
| L2275 |
Plastic mod low ext pad/line |
1,677 |
889 |
$136K |
| E0601 |
Cont airway pressure device |
4,653 |
4,601 |
$132K |
| L1970 |
Afo plastic molded w/ankle j |
221 |
133 |
$122K |
| L2114 |
Afo tib fx semi-rigid |
401 |
376 |
$89K |
| L3030 |
Foot arch support remov prem |
1,804 |
859 |
$87K |
| T4523 |
Adult size brief/diaper lg |
960 |
929 |
$80K |
| L3807 |
Whfo w/o joints pre cst |
527 |
371 |
$68K |
| A7030 |
Cpap full face mask |
702 |
684 |
$65K |
| E0445 |
Oximeter non-invasive |
759 |
748 |
$64K |
| E0483 |
Hi freq chest wall oscil sys |
529 |
528 |
$62K |
| T4535 |
Disposable liner/shield/pad |
1,609 |
1,573 |
$61K |
| A5500 |
Diab shoe for density insert |
1,197 |
597 |
$59K |
| T4522 |
Adult size brief/diaper med |
910 |
884 |
$59K |
| E0431 |
Portable gaseous 02 |
2,674 |
2,578 |
$58K |
| T4524 |
Adult size brief/diaper xl |
618 |
592 |
$58K |
| E0143 |
Walker folding wheeled w/o s |
856 |
838 |
$57K |
| T4521 |
Adult size brief/diaper sm |
808 |
794 |
$55K |
| L3020 |
Foot longitud/metatarsal sup |
669 |
323 |
$55K |
| L1971 |
Afo w/ankle joint, prefab |
238 |
173 |
$54K |
| T4533 |
Youth size brief/diaper |
940 |
910 |
$52K |
| L1832 |
Ko adj jnt pos r sup pre cst |
116 |
100 |
$50K |
| L0627 |
Lo sag ri an/pos pnl pre cst |
206 |
204 |
$48K |
| L2820 |
Soft interface below knee se |
772 |
475 |
$45K |
| E0470 |
Rad w/o backup non-inv intfc |
329 |
323 |
$42K |
| E0562 |
Humidifier heated used w pap |
3,958 |
3,899 |
$40K |
| L1820 |
Ko elas w/ condyle pads & jo |
445 |
327 |
$37K |
| L3216 |
Orthoped ladies shoes dpth i |
1,053 |
522 |
$34K |
| L1833 |
Ko adj jnt pos r sup pre ots |
92 |
68 |
$33K |
| K0001 |
Standard wheelchair |
582 |
568 |
$33K |
| L3002 |
Foot insert plastazote or eq |
426 |
207 |
$32K |
| T4537 |
Reusable underpad bed size |
1,286 |
1,250 |
$32K |
| L3908 |
Who cock-up nonmolde pre ots |
843 |
603 |
$29K |
| L0648 |
Lso sag r an/pos pnl pre ots |
58 |
55 |
$29K |
| T4539 |
Reuse diaper/brief any size |
1,214 |
1,196 |
$28K |
| L0650 |
Lso sc r ant/pos pnl pre ots |
48 |
47 |
$26K |
| A7035 |
Pos airway press headgear |
1,301 |
1,271 |
$26K |
| E0570 |
Nebulizer with compression |
268 |
268 |
$24K |
| E0990 |
Wheelchair elevating leg res |
631 |
592 |
$22K |
| A7034 |
Nasal application device |
878 |
847 |
$21K |
| L3221 |
Orthopedic mens shoes dpth i |
556 |
280 |
$21K |
| A7037 |
Pos airway pressure tubing |
1,358 |
1,317 |
$18K |
| L2112 |
Afo tibial fracture soft |
106 |
101 |
$18K |
| A6539 |
Gc stocking waistlngth 18-30 |
281 |
171 |
$17K |
| A4351 |
Straight tip urine catheter |
209 |
200 |
$16K |
| A5512 |
Multi den insert direct form |
1,120 |
385 |
$15K |
| T4530 |
Ped size brief/diaper lg |
289 |
278 |
$14K |
| L3215 |
Orthopedic ftwear ladies oxf |
226 |
111 |
$13K |
| E0163 |
Commode chair with fixed arm |
171 |
166 |
$13K |
| L1907 |
Afo supramalleolar custom |
52 |
25 |
$12K |
| L1906 |
Afo multilig ank sup pre ots |
227 |
175 |
$12K |
| L2840 |
Tibial length sock fx or equ |
270 |
186 |
$11K |
| T4540 |
Reusable underpad chair size |
795 |
779 |
$10K |
| K0003 |
Lightweight wheelchair |
261 |
247 |
$10K |
| L3219 |
Orthopedic mens shoes oxford |
121 |
60 |
$8K |
| E0482 |
Cough stimulating device |
76 |
76 |
$7K |
| A4927 |
Non-sterile gloves |
2,190 |
2,102 |
$7K |
| L0631 |
Lso sag r an/pos pnl pre cst |
12 |
12 |
$7K |
| E0240 |
Bath/shower chair |
243 |
241 |
$7K |
| E0156 |
Walker seat attachment |
377 |
371 |
$7K |
| A7031 |
Replacement facemask interfa |
104 |
104 |
$7K |
| A6402 |
Sterile gauze <= 16 sq in |
506 |
482 |
$7K |
| L3217 |
Ladies shoes hightop depth i |
106 |
52 |
$6K |
| A4624 |
Tracheal suction tube |
51 |
45 |
$6K |
| E0465 |
Home vent invasive interface |
14 |
12 |
$5K |
| A7032 |
Replacement nasal cushion |
115 |
113 |
$5K |
| A6530 |
Compression stocking bk18-30 |
207 |
108 |
$4K |
| L4396 |
Static or dynami afo pre cst |
42 |
26 |
$4K |
| A4402 |
Lubricant per ounce |
890 |
863 |
$4K |
| L2270 |
Varus/valgus strap padded/li |
145 |
86 |
$4K |
| E0100 |
Cane adjust/fixed with tip |
380 |
377 |
$3K |
| A5120 |
Skin barrier, wipe or swab |
347 |
343 |
$3K |
| A7038 |
Pos airway pressure filter |
1,292 |
1,249 |
$3K |
| E0114 |
Crutch underarm pair no wood |
178 |
172 |
$3K |
| A7005 |
Nondisposable nebulizer set |
226 |
226 |
$3K |
| A5513 |
Multi den insert custom mold |
110 |
39 |
$2K |
| L3995 |
Sock fracture or equal each |
47 |
40 |
$2K |
| L2220 |
Dorsi & plantar flex ass/res |
22 |
12 |
$2K |
| A6533 |
Gc stocking thighlngth 18-30 |
73 |
38 |
$2K |
| B4035 |
Enteral feed supp pump per d |
12 |
12 |
$1K |
| E0561 |
Humidifier nonheated w pap |
110 |
108 |
$1K |
| A7036 |
Pos airway press chinstrap |
101 |
101 |
$1K |
| E0261 |
Hosp bed semi-electr w/o mat |
25 |
24 |
$1K |
| L1902 |
Afo ankle gauntlet pre ots |
30 |
25 |
$1K |
| E0247 |
Trans bench w/wo comm open |
14 |
14 |
$1K |
| S8101 |
Spacer with mask |
35 |
33 |
$932.40 |
| L3060 |
Foot arch supp longitud/meta |
26 |
13 |
$833.60 |
| A7000 |
Disposable canister for pump |
70 |
68 |
$748.20 |
| E0241 |
Bath tub wall rail |
15 |
15 |
$606.37 |
| A4217 |
Sterile water/saline, 500 ml |
79 |
48 |
$451.21 |
| A4604 |
Tubing with heating element |
12 |
12 |
$432.52 |
| E1399 |
Durable medical equipment mi |
19 |
12 |
$340.02 |
| L2755 |
Carbon graphite lamination |
21 |
12 |
$336.00 |
| A4450 |
Non-waterproof tape |
39 |
37 |
$287.33 |
| A7039 |
Filter, non disposable w pap |
189 |
179 |
$280.50 |
| E0244 |
Toilet seat raised |
15 |
15 |
$235.06 |
| A7002 |
Tubing used w suction pump |
94 |
72 |
$222.31 |
| A6446 |
Conform band s w>=3" <5"/yd |
26 |
25 |
$216.96 |
| A7015 |
Aerosol mask used w nebulize |
22 |
22 |
$18.70 |
| 99080 |
|
2,466 |
1,884 |
$0.00 |
| A7046 |
Repl water chamber, pap dev |
90 |
85 |
$0.00 |
| E0575 |
Nebulizer ultrasonic |
20 |
20 |
$0.00 |