| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
5,751 |
2,196 |
$306K |
| T4526 |
Adult size pull-on med |
4,063 |
2,494 |
$127K |
| T4527 |
Adult size pull-on lg |
2,555 |
1,582 |
$110K |
| T4528 |
Adult size pull-on xl |
2,230 |
1,450 |
$84K |
| T4541 |
Large disposable underpad |
13,722 |
8,690 |
$72K |
| A4351 |
Straight tip urine catheter |
2,893 |
2,012 |
$67K |
| A4335 |
Incontinence supply |
9,893 |
4,067 |
$61K |
| K0823 |
Pwc gp 2 std cap chair |
1,501 |
692 |
$60K |
| A4927 |
Non-sterile gloves |
16,277 |
8,427 |
$57K |
| T4544 |
Adlt disp und/pull on abv xl |
458 |
192 |
$52K |
| T4524 |
Adult size brief/diaper xl |
489 |
344 |
$27K |
| K0001 |
Standard wheelchair |
3,614 |
2,445 |
$26K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,902 |
1,377 |
$25K |
| T4522 |
Adult size brief/diaper med |
1,027 |
753 |
$24K |
| T4523 |
Adult size brief/diaper lg |
945 |
641 |
$21K |
| E0600 |
Suction pump portab hom modl |
1,473 |
871 |
$18K |
| A6446 |
Conform band s w>=3" <5"/yd |
1,203 |
896 |
$15K |
| A4628 |
Oropharyngeal suction cath |
3,963 |
2,228 |
$13K |
| A7000 |
Disposable canister for pump |
4,218 |
2,509 |
$13K |
| A7002 |
Tubing used w suction pump |
3,853 |
2,405 |
$12K |
| B4150 |
Ef complet w/intact nutrient |
340 |
227 |
$10K |
| A4624 |
Tracheal suction tube |
615 |
385 |
$9K |
| A4402 |
Lubricant per ounce |
2,414 |
1,803 |
$8K |
| E0245 |
Tub stool or bench |
784 |
423 |
$7K |
| T4535 |
Disposable liner/shield/pad |
309 |
217 |
$7K |
| E0630 |
Patient lift hydraulic |
694 |
507 |
$7K |
| A4606 |
Oxygen probe used w oximeter |
126 |
61 |
$7K |
| A9270 |
Non-covered item or service |
2,100 |
1,622 |
$6K |
| E1390 |
Oxygen concentrator |
239 |
181 |
$5K |
| A6402 |
Sterile gauze <= 16 sq in |
2,365 |
1,566 |
$4K |
| T4543 |
Adult disp brief/diap abv xl |
130 |
72 |
$4K |
| E0445 |
Oximeter non-invasive |
50 |
25 |
$4K |
| A7526 |
Tracheostomy tube collar |
266 |
174 |
$3K |
| A4670 |
Automatic bp monitor, dial |
1,180 |
694 |
$3K |
| A4483 |
Moisture exchanger |
167 |
119 |
$3K |
| E1038 |
Transport chair pt wt<=300lb |
1,450 |
1,072 |
$3K |
| A5512 |
Multi den insert direct form |
102 |
38 |
$2K |
| A4322 |
Irrigation syringe |
119 |
78 |
$2K |
| A4450 |
Non-waterproof tape |
1,469 |
1,118 |
$2K |
| E0240 |
Bath/shower chair |
160 |
91 |
$2K |
| A4349 |
Disposable male external cat |
146 |
108 |
$2K |
| A4217 |
Sterile water/saline, 500 ml |
857 |
649 |
$2K |
| E1031 |
Rollabout chair with casters |
270 |
228 |
$1K |
| K0738 |
Portable gas oxygen system |
180 |
130 |
$1K |
| A4357 |
Bedside drainage bag |
552 |
423 |
$1K |
| A5500 |
Diab shoe for density insert |
83 |
25 |
$1K |
| E2365 |
U1 sealed leadacid battery |
14 |
12 |
$1K |
| A6216 |
Non-sterile gauze<=16 sq in |
780 |
662 |
$988.64 |
| K0739 |
Repair/svc dme non-oxygen eq |
73 |
39 |
$358.41 |
| A4358 |
Urinary leg or abdomen bag |
100 |
81 |
$281.56 |
| E0570 |
Nebulizer with compression |
146 |
87 |
$147.68 |
| A7003 |
Nebulizer administration set |
359 |
249 |
$109.22 |
| K0195 |
Elevating whlchair leg rests |
192 |
151 |
$0.00 |
| K0007 |
Extra heavy duty wheelchair |
153 |
118 |
$0.00 |
| K0006 |
Heavy duty wheelchair |
120 |
82 |
$0.00 |
| K0003 |
Lightweight wheelchair |
96 |
75 |
$0.00 |
| T4534 |
Youth size pull-on |
12 |
12 |
$0.00 |
| E1226 |
Manual fully reclining back |
106 |
62 |
$0.00 |