| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6549 |
Grad com garm noc day use |
2,791 |
841 |
$556K |
| E0601 |
Cont airway pressure device |
4,002 |
3,915 |
$432K |
| S9999 |
Sales tax |
14,634 |
13,234 |
$264K |
| E0562 |
Humidifier heated used w pap |
1,572 |
1,529 |
$197K |
| A7030 |
Cpap full face mask |
1,148 |
1,133 |
$157K |
| E0570 |
Nebulizer with compression |
3,407 |
3,280 |
$141K |
| E0143 |
Walker folding wheeled w/o s |
2,906 |
2,863 |
$140K |
| A7034 |
Nasal application device |
1,558 |
1,535 |
$135K |
| E0114 |
Crutch underarm pair no wood |
1,822 |
1,816 |
$88K |
| A7035 |
Pos airway press headgear |
3,005 |
2,953 |
$87K |
| A4604 |
Tubing with heating element |
1,850 |
1,820 |
$84K |
| K0001 |
Standard wheelchair |
3,140 |
3,069 |
$72K |
| A6196 |
Alginate dressing <=16 sq in |
450 |
428 |
$69K |
| A7038 |
Pos airway pressure filter |
4,453 |
4,370 |
$36K |
| E0630 |
Patient lift hydraulic |
920 |
900 |
$35K |
| A7037 |
Pos airway pressure tubing |
1,001 |
991 |
$30K |
| E0260 |
Hosp bed semi-electr w/ matt |
864 |
833 |
$21K |
| A7046 |
Repl water chamber, pap dev |
963 |
947 |
$14K |
| T4535 |
Disposable liner/shield/pad |
287 |
277 |
$13K |
| A7039 |
Filter, non disposable w pap |
969 |
956 |
$11K |
| A6446 |
Conform band s w>=3" <5"/yd |
767 |
719 |
$10K |
| A7031 |
Replacement facemask interfa |
240 |
234 |
$9K |
| E0470 |
Rad w/o backup non-inv intfc |
25 |
25 |
$8K |
| A4927 |
Non-sterile gloves |
817 |
766 |
$8K |
| A6402 |
Sterile gauze <= 16 sq in |
1,016 |
958 |
$8K |
| E0294 |
Hosp bed semi-elect w/ mattr |
92 |
92 |
$7K |
| A7005 |
Nondisposable nebulizer set |
188 |
184 |
$5K |
| A4452 |
Waterproof tape |
202 |
195 |
$5K |
| T4541 |
Large disposable underpad |
81 |
76 |
$3K |
| A4450 |
Non-waterproof tape |
834 |
776 |
$3K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
65 |
60 |
$2K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
26 |
26 |
$2K |
| T4527 |
Adult size pull-on lg |
12 |
12 |
$1K |
| A7032 |
Replacement nasal cushion |
38 |
38 |
$888.59 |
| E0149 |
Heavy duty wheeled walker |
14 |
12 |
$579.04 |
| E0156 |
Walker seat attachment |
37 |
37 |
$367.94 |
| T4537 |
Reusable underpad bed size |
12 |
12 |
$358.76 |
| E0100 |
Cane adjust/fixed with tip |
13 |
13 |
$222.46 |