| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/pad |
12,823 |
12,149 |
$682K |
| T4527 |
Adult size pull-on lg |
4,618 |
4,362 |
$441K |
| T4528 |
Adult size pull-on xl |
3,626 |
3,458 |
$429K |
| T4526 |
Adult size pull-on med |
4,626 |
4,442 |
$393K |
| T4541 |
Large disposable underpad |
8,561 |
8,104 |
$324K |
| E1390 |
Oxygen concentrator |
4,336 |
4,321 |
$269K |
| T1999 |
Noc retail items andsupplies |
735 |
700 |
$141K |
| T4537 |
Reusable underpad bed size |
1,310 |
1,304 |
$137K |
| T4543 |
Adult disp brief/diap abv xl |
661 |
619 |
$136K |
| T4544 |
Adlt disp und/pull on abv xl |
502 |
489 |
$86K |
| T4525 |
Adult size pull-on sm |
1,195 |
1,142 |
$79K |
| A4335 |
Incontinence supply |
2,218 |
2,135 |
$49K |
| A4927 |
Non-sterile gloves |
1,813 |
1,762 |
$45K |
| E0601 |
Cont airway pressure device |
561 |
559 |
$30K |
| E0570 |
Nebulizer with compression |
1,061 |
1,056 |
$21K |
| E1392 |
Portable oxygen concentrator |
1,467 |
1,465 |
$21K |
| E0260 |
Hosp bed semi-electr w/ matt |
726 |
722 |
$18K |
| E0431 |
Portable gaseous 02 |
1,502 |
1,491 |
$17K |
| E0562 |
Humidifier heated used w pap |
605 |
603 |
$14K |
| E1399 |
Durable medical equipment mi |
130 |
126 |
$11K |
| E0470 |
Rad w/o backup non-inv intfc |
100 |
100 |
$11K |
| K0001 |
Standard wheelchair |
438 |
437 |
$11K |
| B4150 |
Ef complet w/intact nutrient |
55 |
49 |
$7K |
| E0240 |
Bath/shower chair |
29 |
29 |
$2K |
| A7030 |
Cpap full face mask |
12 |
12 |
$1K |
| A4253 |
Blood glucose/reagent strips |
141 |
128 |
$487.63 |
| A7038 |
Pos airway pressure filter |
136 |
135 |
$464.56 |
| A7035 |
Pos airway press headgear |
29 |
29 |
$378.66 |
| A7003 |
Nebulizer administration set |
40 |
40 |
$94.91 |