| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
18,356 |
15,997 |
$606K |
| T4528 |
Adult size pull-on xl |
5,255 |
4,525 |
$368K |
| X1939 |
|
5,414 |
5,358 |
$334K |
| T4543 |
Adult disp brief/diap abv xl |
2,065 |
1,802 |
$275K |
| T4527 |
Adult size pull-on lg |
4,993 |
4,651 |
$265K |
| T4526 |
Adult size pull-on med |
4,936 |
4,299 |
$235K |
| T5999 |
Supply, nos |
28,593 |
23,799 |
$232K |
| T4524 |
Adult size brief/diaper xl |
2,011 |
1,571 |
$208K |
| E1390 |
Oxygen concentrator |
2,877 |
2,750 |
$184K |
| T2028 |
Special supply, nos waiver |
1,283 |
1,212 |
$115K |
| T4522 |
Adult size brief/diaper med |
1,670 |
1,252 |
$98K |
| E0260 |
Hosp bed semi-electr w/ matt |
2,079 |
1,924 |
$97K |
| E0570 |
Nebulizer with compression |
3,341 |
2,839 |
$93K |
| E0601 |
Cont airway pressure device |
3,222 |
3,002 |
$91K |
| T4523 |
Adult size brief/diaper lg |
1,218 |
932 |
$90K |
| X1922 |
|
572 |
551 |
$76K |
| T4535 |
Disposable liner/shield/pad |
2,301 |
2,218 |
$67K |
| X1915 |
|
685 |
665 |
$62K |
| K0001 |
Standard wheelchair |
3,669 |
3,269 |
$60K |
| A4927 |
Non-sterile gloves |
3,558 |
2,000 |
$39K |
| E0431 |
Portable gaseous 02 |
2,802 |
2,577 |
$32K |
| A5512 |
Multi den insert direct form |
694 |
359 |
$27K |
| A5500 |
Diab shoe for density insert |
720 |
372 |
$23K |
| A4604 |
Tubing with heating element |
783 |
736 |
$15K |
| A4253 |
Blood glucose/reagent strips |
1,230 |
1,203 |
$13K |
| A7035 |
Pos airway press headgear |
688 |
636 |
$8K |
| A7005 |
Nondisposable nebulizer set |
445 |
400 |
$8K |
| A7030 |
Cpap full face mask |
88 |
77 |
$5K |
| E0630 |
Patient lift hydraulic |
94 |
89 |
$4K |
| A7038 |
Pos airway pressure filter |
1,457 |
1,366 |
$3K |
| A4259 |
Lancets per box |
977 |
955 |
$2K |
| A7046 |
Repl water chamber, pap dev |
137 |
123 |
$836.45 |
| A7034 |
Nasal application device |
16 |
15 |
$540.20 |
| E0143 |
Walker folding wheeled w/o s |
16 |
14 |
$404.85 |
| E0149 |
Heavy duty wheeled walker |
40 |
40 |
$232.86 |
| A7015 |
Aerosol mask used w nebulize |
13 |
13 |
$22.85 |