| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult size pull-on xl |
853 |
818 |
$173K |
| T4527 |
Adult size pull-on lg |
729 |
696 |
$128K |
| A7030 |
Cpap full face mask |
2,019 |
1,878 |
$120K |
| E0601 |
Cont airway pressure device |
3,469 |
3,240 |
$114K |
| A7034 |
Nasal application device |
2,225 |
2,055 |
$101K |
| A4604 |
Tubing with heating element |
3,584 |
3,327 |
$90K |
| E1390 |
Oxygen concentrator |
2,029 |
1,823 |
$90K |
| T4535 |
Disposable liner/shield/pad |
938 |
884 |
$81K |
| A7031 |
Replacement facemask interfa |
2,136 |
1,973 |
$62K |
| T4532 |
Ped size pull-on lg |
261 |
234 |
$59K |
| T4526 |
Adult size pull-on med |
351 |
337 |
$57K |
| T4541 |
Large disposable underpad |
1,190 |
1,141 |
$50K |
| E0562 |
Humidifier heated used w pap |
2,966 |
2,770 |
$47K |
| E0570 |
Nebulizer with compression |
2,796 |
2,673 |
$47K |
| S9999 |
Sales tax |
4,795 |
4,257 |
$46K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,687 |
1,571 |
$45K |
| A7033 |
Replacement nasal pillows |
1,387 |
1,271 |
$35K |
| A4927 |
Non-sterile gloves |
676 |
647 |
$33K |
| A7035 |
Pos airway press headgear |
2,434 |
2,252 |
$31K |
| K0001 |
Standard wheelchair |
2,091 |
1,951 |
$31K |
| T4537 |
Reusable underpad bed size |
975 |
938 |
$30K |
| A7032 |
Replacement nasal cushion |
848 |
780 |
$30K |
| A7038 |
Pos airway pressure filter |
4,423 |
4,086 |
$18K |
| A7046 |
Repl water chamber, pap dev |
1,863 |
1,710 |
$15K |
| T4525 |
Adult size pull-on sm |
90 |
84 |
$14K |
| T4531 |
Ped size pull-on sm/med |
81 |
73 |
$14K |
| E0431 |
Portable gaseous 02 |
1,323 |
1,164 |
$12K |
| E0143 |
Walker folding wheeled w/o s |
333 |
321 |
$9K |
| E0466 |
Home vent non-invasive inter |
32 |
26 |
$9K |
| T4522 |
Adult size brief/diaper med |
58 |
53 |
$7K |
| K0007 |
Extra heavy duty wheelchair |
165 |
146 |
$5K |
| A7037 |
Pos airway pressure tubing |
309 |
281 |
$3K |
| K0195 |
Elevating whlchair leg rests |
560 |
533 |
$3K |
| E0156 |
Walker seat attachment |
315 |
306 |
$2K |
| E0971 |
Wheelchair anti-tipping devi |
295 |
186 |
$905.46 |
| E0149 |
Heavy duty wheeled walker |
345 |
331 |
$684.48 |
| A7039 |
Filter, non disposable w pap |
12 |
12 |
$42.93 |