| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
3,086 |
2,767 |
$122K |
| T4525 |
Adult size pull-on sm |
614 |
586 |
$104K |
| T4528 |
Adult size pull-on xl |
617 |
592 |
$94K |
| T4527 |
Adult size pull-on lg |
575 |
546 |
$88K |
| A4927 |
Non-sterile gloves |
2,393 |
2,136 |
$43K |
| E1390 |
Oxygen concentrator |
1,365 |
1,234 |
$21K |
| E0431 |
Portable gaseous 02 |
793 |
724 |
$19K |
| T4535 |
Disposable liner/shield/pad |
212 |
212 |
$15K |
| A4553 |
Nondisp underpads, all sizes |
1,043 |
920 |
$13K |
| E0260 |
Hosp bed semi-electr w/ matt |
682 |
655 |
$10K |
| A7038 |
Pos airway pressure filter |
629 |
558 |
$6K |
| E0601 |
Cont airway pressure device |
477 |
452 |
$5K |
| E0570 |
Nebulizer with compression |
1,247 |
1,149 |
$4K |
| T4537 |
Reusable underpad bed size |
724 |
714 |
$3K |
| A4253 |
Blood glucose/reagent strips |
787 |
743 |
$3K |
| K0001 |
Standard wheelchair |
404 |
360 |
$3K |
| Q0513 |
Disp fee inhal drugs/30 days |
259 |
170 |
$2K |
| A7035 |
Pos airway press headgear |
121 |
99 |
$2K |
| A7031 |
Replacement facemask interfa |
63 |
54 |
$1K |
| A7030 |
Cpap full face mask |
36 |
29 |
$1K |
| A7034 |
Nasal application device |
25 |
19 |
$853.88 |
| A4604 |
Tubing with heating element |
59 |
44 |
$555.12 |
| A7046 |
Repl water chamber, pap dev |
37 |
30 |
$481.22 |
| A7037 |
Pos airway pressure tubing |
46 |
41 |
$438.69 |
| A7032 |
Replacement nasal cushion |
22 |
14 |
$432.00 |
| A4259 |
Lancets per box |
87 |
80 |
$89.08 |
| A7003 |
Nebulizer administration set |
51 |
32 |
$83.13 |
| A7015 |
Aerosol mask used w nebulize |
20 |
13 |
$14.12 |
| A7039 |
Filter, non disposable w pap |
14 |
12 |
$0.00 |