| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S5199 |
Personal care item nos each |
1,969 |
1,863 |
$162K |
| A4554 |
Disposable underpads |
1,911 |
1,861 |
$91K |
| T4526 |
Adult size pull-on med |
612 |
582 |
$75K |
| T4527 |
Adult size pull-on lg |
520 |
506 |
$58K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,087 |
657 |
$56K |
| E0260 |
Hosp bed semi-electr w/ matt |
4,664 |
3,239 |
$20K |
| A4927 |
Non-sterile gloves |
1,704 |
1,456 |
$19K |
| E0601 |
Cont airway pressure device |
741 |
570 |
$19K |
| K0001 |
Standard wheelchair |
5,287 |
3,495 |
$16K |
| B4034 |
Enter feed supkit syr by day |
722 |
409 |
$12K |
| A4253 |
Blood glucose/reagent strips |
2,300 |
1,694 |
$10K |
| K0003 |
Lightweight wheelchair |
1,495 |
997 |
$7K |
| E0630 |
Patient lift hydraulic |
972 |
641 |
$6K |
| E0570 |
Nebulizer with compression |
2,176 |
1,298 |
$5K |
| E0143 |
Walker folding wheeled w/o s |
646 |
450 |
$4K |
| E1390 |
Oxygen concentrator |
155 |
103 |
$2K |
| E0163 |
Commode chair with fixed arm |
311 |
223 |
$2K |
| E0562 |
Humidifier heated used w pap |
424 |
355 |
$2K |
| K0195 |
Elevating whlchair leg rests |
1,240 |
844 |
$1K |
| A4259 |
Lancets per box |
2,142 |
1,579 |
$1K |
| E1038 |
Transport chair pt wt<=300lb |
1,779 |
1,313 |
$1K |
| A7003 |
Nebulizer administration set |
292 |
188 |
$317.54 |
| Q0513 |
Disp fee inhal drugs/30 days |
63 |
41 |
$202.31 |
| A4256 |
Calibrator solution/chips |
372 |
256 |
$135.38 |
| E0277 |
Powered pres-redu air mattrs |
32 |
24 |
$69.10 |
| E0156 |
Walker seat attachment |
176 |
130 |
$60.80 |
| A7015 |
Aerosol mask used w nebulize |
180 |
113 |
$48.16 |
| A4258 |
Lancet device each |
60 |
36 |
$24.58 |