| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
8,458 |
5,473 |
$448K |
| T4541 |
Large disposable underpad |
12,317 |
12,091 |
$425K |
| B4150 |
Ef complet w/intact nutrient |
3,332 |
2,978 |
$410K |
| T4527 |
Adult size pull-on lg |
7,711 |
7,588 |
$382K |
| T4528 |
Adult size pull-on xl |
5,485 |
5,391 |
$316K |
| T4535 |
Disposable liner/shield/pad |
7,318 |
7,159 |
$310K |
| T4526 |
Adult size pull-on med |
7,089 |
6,928 |
$309K |
| A4245 |
Alcohol wipes per box |
26,582 |
26,109 |
$207K |
| T4524 |
Adult size brief/diaper xl |
2,900 |
2,862 |
$189K |
| A4554 |
Disposable underpads |
6,154 |
6,105 |
$177K |
| B4154 |
Ef spec metabolic noninherit |
790 |
724 |
$147K |
| T4543 |
Adult disp brief/diap abv xl |
2,095 |
2,058 |
$141K |
| E0601 |
Cont airway pressure device |
1,779 |
1,722 |
$121K |
| K0001 |
Standard wheelchair |
7,422 |
5,305 |
$117K |
| B4152 |
Ef calorie dense>/=1.5kcal |
854 |
733 |
$101K |
| T4523 |
Adult size brief/diaper lg |
1,838 |
1,813 |
$96K |
| A4927 |
Non-sterile gloves |
14,064 |
13,746 |
$94K |
| E0431 |
Portable gaseous 02 |
8,004 |
5,160 |
$71K |
| E0570 |
Nebulizer with compression |
2,921 |
1,986 |
$59K |
| T4522 |
Adult size brief/diaper med |
1,395 |
1,375 |
$58K |
| E1399 |
Durable medical equipment mi |
340 |
293 |
$53K |
| T4525 |
Adult size pull-on sm |
1,046 |
1,042 |
$51K |
| A6250 |
Skin seal protect moisturizr |
6,879 |
6,656 |
$49K |
| E0255 |
Hospital bed var ht w/ mattr |
1,547 |
966 |
$39K |
| E0143 |
Walker folding wheeled w/o s |
987 |
694 |
$28K |
| T4540 |
Reusable underpad chair size |
1,110 |
1,093 |
$21K |
| A4930 |
Sterile, gloves per pair |
554 |
538 |
$19K |
| E0562 |
Humidifier heated used w pap |
2,343 |
2,231 |
$18K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,340 |
740 |
$15K |
| E0630 |
Patient lift hydraulic |
599 |
380 |
$11K |
| E0163 |
Commode chair with fixed arm |
618 |
404 |
$11K |
| A4335 |
Incontinence supply |
1,944 |
1,913 |
$11K |
| K0195 |
Elevating whlchair leg rests |
1,436 |
1,146 |
$7K |
| E0971 |
Wheelchair anti-tipping devi |
451 |
248 |
$3K |
| A4216 |
Sterile water/saline, 10 ml |
49 |
49 |
$2K |
| A6402 |
Sterile gauze <= 16 sq in |
49 |
49 |
$1K |
| A7003 |
Nebulizer administration set |
425 |
375 |
$824.39 |
| A5120 |
Skin barrier, wipe or swab |
12 |
12 |
$541.42 |
| A7015 |
Aerosol mask used w nebulize |
355 |
315 |
$284.86 |
| E1038 |
Transport chair pt wt<=300lb |
140 |
80 |
$98.34 |