| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2029 |
Special med equip, noswaiver |
2,785 |
1,886 |
$409K |
| T4528 |
Adult size pull-on xl |
2,544 |
2,499 |
$376K |
| T4527 |
Adult size pull-on lg |
2,891 |
2,753 |
$343K |
| E1390 |
Oxygen concentrator |
4,369 |
3,908 |
$282K |
| T4526 |
Adult size pull-on med |
2,320 |
2,224 |
$242K |
| T4535 |
Disposable liner/shield/pad |
2,441 |
2,322 |
$210K |
| T4541 |
Large disposable underpad |
2,943 |
2,820 |
$147K |
| T4523 |
Adult size brief/diaper lg |
696 |
678 |
$131K |
| A4927 |
Non-sterile gloves |
2,414 |
2,362 |
$86K |
| E0601 |
Cont airway pressure device |
2,051 |
1,894 |
$78K |
| E1161 |
Manual adult wc w tiltinspac |
178 |
167 |
$73K |
| A7030 |
Cpap full face mask |
646 |
601 |
$56K |
| A4604 |
Tubing with heating element |
1,436 |
1,356 |
$54K |
| E0260 |
Hosp bed semi-electr w/ matt |
785 |
755 |
$48K |
| A7031 |
Replacement facemask interfa |
1,456 |
1,346 |
$47K |
| E1028 |
W/c manual swingaway |
948 |
620 |
$45K |
| K0108 |
W/c component-accessory nos |
323 |
186 |
$42K |
| E0431 |
Portable gaseous 02 |
2,579 |
2,413 |
$40K |
| K0001 |
Standard wheelchair |
806 |
779 |
$28K |
| E0973 |
W/ch access det adj armrest |
296 |
209 |
$26K |
| K0739 |
Repair/svc dme non-oxygen eq |
525 |
459 |
$25K |
| T4534 |
Youth size pull-on |
133 |
131 |
$18K |
| E0955 |
Cushioned headrest |
395 |
383 |
$15K |
| A7035 |
Pos airway press headgear |
852 |
763 |
$15K |
| E0570 |
Nebulizer with compression |
794 |
768 |
$14K |
| A7038 |
Pos airway pressure filter |
3,179 |
3,041 |
$14K |
| E0118 |
Crutch substitute |
476 |
468 |
$13K |
| T4524 |
Adult size brief/diaper xl |
51 |
51 |
$11K |
| E0971 |
Wheelchair anti-tipping devi |
213 |
154 |
$10K |
| A7032 |
Replacement nasal cushion |
274 |
263 |
$9K |
| T4525 |
Adult size pull-on sm |
69 |
67 |
$8K |
| A7046 |
Repl water chamber, pap dev |
357 |
348 |
$5K |
| A4357 |
Bedside drainage bag |
198 |
186 |
$5K |
| A7034 |
Nasal application device |
44 |
44 |
$3K |
| E2611 |
Gen use back cush wdth <22in |
12 |
12 |
$3K |
| E0562 |
Humidifier heated used w pap |
351 |
306 |
$3K |
| K0040 |
Adjustable angle footplate |
15 |
12 |
$1K |
| E0978 |
W/c acc,saf belt pelv strap |
25 |
24 |
$652.29 |
| A7005 |
Nondisposable nebulizer set |
71 |
68 |
$521.38 |
| A7003 |
Nebulizer administration set |
15 |
15 |
$62.36 |
| A7013 |
Disposable compressor filter |
67 |
64 |
$53.43 |