| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4526 |
Adult size pull-on med |
4,172 |
3,947 |
$399K |
| T4527 |
Adult size pull-on lg |
4,121 |
3,907 |
$376K |
| T4528 |
Adult size pull-on xl |
3,398 |
3,192 |
$311K |
| A4554 |
Disposable underpads |
9,403 |
8,941 |
$275K |
| T4535 |
Disposable liner/shield/pad |
2,158 |
2,048 |
$97K |
| A4927 |
Non-sterile gloves |
5,339 |
5,001 |
$60K |
| E1390 |
Oxygen concentrator |
1,528 |
1,411 |
$59K |
| T4523 |
Adult size brief/diaper lg |
703 |
620 |
$58K |
| E0601 |
Cont airway pressure device |
2,039 |
1,635 |
$57K |
| A5120 |
Skin barrier, wipe or swab |
3,090 |
2,820 |
$29K |
| E0260 |
Hosp bed semi-electr w/ matt |
830 |
769 |
$23K |
| A7031 |
Replacement facemask interfa |
1,070 |
1,022 |
$13K |
| K0001 |
Standard wheelchair |
473 |
442 |
$3K |
| K0002 |
Stnd hemi (low seat) whlchr |
175 |
165 |
$3K |
| E0143 |
Walker folding wheeled w/o s |
58 |
50 |
$3K |
| E0570 |
Nebulizer with compression |
79 |
76 |
$2K |
| A7032 |
Replacement nasal cushion |
214 |
202 |
$2K |
| A7038 |
Pos airway pressure filter |
2,505 |
2,383 |
$1K |
| T4522 |
Adult size brief/diaper med |
13 |
12 |
$1K |
| T4524 |
Adult size brief/diaper xl |
14 |
13 |
$1K |
| A7030 |
Cpap full face mask |
13 |
13 |
$381.03 |
| E0431 |
Portable gaseous 02 |
930 |
901 |
$330.43 |
| A7037 |
Pos airway pressure tubing |
113 |
101 |
$300.28 |
| A7035 |
Pos airway press headgear |
125 |
110 |
$300.24 |
| E2203 |
Frame depth less than 22 in |
113 |
107 |
$228.32 |
| E2201 |
Man w/ch acc seat w>=20"<24" |
51 |
49 |
$202.78 |
| A7046 |
Repl water chamber, pap dev |
32 |
29 |
$105.65 |
| A7039 |
Filter, non disposable w pap |
64 |
61 |
$73.97 |