| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0570 |
Nebulizer with compression |
11,148 |
11,011 |
$832K |
| A4554 |
Disposable underpads |
12,973 |
12,880 |
$461K |
| T4527 |
Adult size pull-on lg |
3,455 |
3,441 |
$379K |
| T4526 |
Adult size pull-on med |
3,257 |
3,237 |
$294K |
| T4528 |
Adult size pull-on xl |
1,586 |
1,582 |
$226K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,182 |
1,178 |
$221K |
| T4535 |
Disposable liner/shield/pad |
5,473 |
5,454 |
$168K |
| B4150 |
Ef complet w/intact nutrient |
493 |
479 |
$125K |
| A4670 |
Automatic bp monitor, dial |
1,782 |
1,750 |
$100K |
| E0601 |
Cont airway pressure device |
2,356 |
2,302 |
$100K |
| A4335 |
Incontinence supply |
16,938 |
16,829 |
$91K |
| T4534 |
Youth size pull-on |
889 |
880 |
$85K |
| K0001 |
Standard wheelchair |
2,722 |
2,694 |
$55K |
| T4532 |
Ped size pull-on lg |
287 |
287 |
$32K |
| E0562 |
Humidifier heated used w pap |
2,486 |
2,428 |
$29K |
| E0260 |
Hosp bed semi-electr w/ matt |
892 |
886 |
$28K |
| A6530 |
Compression stocking bk18-30 |
184 |
91 |
$23K |
| A7030 |
Cpap full face mask |
286 |
280 |
$22K |
| A7003 |
Nebulizer administration set |
9,233 |
9,116 |
$16K |
| A4253 |
Blood glucose/reagent strips |
1,317 |
1,311 |
$13K |
| A9900 |
Supply/accessory/service |
158 |
150 |
$11K |
| A7015 |
Aerosol mask used w nebulize |
9,226 |
9,114 |
$11K |
| A6533 |
Gc stocking thighlngth 18-30 |
50 |
25 |
$10K |
| S1015 |
Iv tubing extension set |
386 |
363 |
$9K |
| E0114 |
Crutch underarm pair no wood |
257 |
251 |
$7K |
| E0603 |
Electric breast pump |
56 |
54 |
$7K |
| A7037 |
Pos airway pressure tubing |
699 |
690 |
$7K |
| T4523 |
Adult size brief/diaper lg |
62 |
62 |
$6K |
| B4034 |
Enter feed supkit syr by day |
60 |
54 |
$6K |
| A4209 |
5+ cc sterile syringe&needle |
505 |
471 |
$6K |
| E0143 |
Walker folding wheeled w/o s |
177 |
173 |
$5K |
| A6402 |
Sterile gauze <= 16 sq in |
950 |
854 |
$5K |
| A7035 |
Pos airway press headgear |
299 |
294 |
$4K |
| S8101 |
Spacer with mask |
199 |
188 |
$4K |
| A7038 |
Pos airway pressure filter |
1,101 |
1,083 |
$4K |
| A6258 |
Transparent film >16<=48 in |
452 |
422 |
$4K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
183 |
172 |
$4K |
| E1390 |
Oxygen concentrator |
40 |
40 |
$3K |
| A5200 |
Percutaneous catheter anchor |
101 |
90 |
$3K |
| A4452 |
Waterproof tape |
476 |
449 |
$3K |
| A6203 |
Composite drsg <= 16 sq in |
295 |
278 |
$2K |
| A4259 |
Lancets per box |
1,234 |
1,230 |
$1K |
| T4522 |
Adult size brief/diaper med |
13 |
13 |
$1K |
| A7034 |
Nasal application device |
25 |
25 |
$1K |
| K0003 |
Lightweight wheelchair |
131 |
131 |
$1K |
| A4245 |
Alcohol wipes per box |
612 |
578 |
$977.61 |
| A7031 |
Replacement facemask interfa |
27 |
27 |
$971.94 |
| E0159 |
Brake for wheeled walker |
149 |
147 |
$255.90 |
| A4248 |
Chlorhexidine antisept |
114 |
107 |
$232.84 |
| E0431 |
Portable gaseous 02 |
12 |
12 |
$173.81 |
| A4216 |
Sterile water/saline, 10 ml |
12 |
12 |
$74.40 |
| E0156 |
Walker seat attachment |
38 |
38 |
$14.52 |
| 0001A |
|
24 |
24 |
$0.00 |
| 99401 |
|
13 |
13 |
$0.00 |
| 0013A |
|
16 |
16 |
$0.00 |
| 0002A |
|
23 |
23 |
$0.00 |
| 0003A |
|
20 |
20 |
$0.00 |