| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
3,332 |
3,315 |
$386K |
| E0570 |
Nebulizer with compression |
2,465 |
2,450 |
$236K |
| T4541 |
Large disposable underpad |
6,260 |
6,192 |
$235K |
| K0108 |
W/c component-accessory nos |
1,016 |
401 |
$168K |
| T4535 |
Disposable liner/shield/pad |
3,235 |
3,202 |
$155K |
| K0001 |
Standard wheelchair |
2,031 |
1,993 |
$151K |
| A4670 |
Automatic bp monitor, dial |
1,274 |
1,271 |
$133K |
| E0143 |
Walker folding wheeled w/o s |
1,802 |
1,773 |
$117K |
| E0601 |
Cont airway pressure device |
947 |
926 |
$112K |
| E0295 |
Hosp bed semi-elect w/o matt |
611 |
601 |
$102K |
| T4527 |
Adult size pull-on lg |
1,563 |
1,553 |
$95K |
| K0739 |
Repair/svc dme non-oxygen eq |
629 |
611 |
$94K |
| K0003 |
Lightweight wheelchair |
605 |
591 |
$73K |
| T4526 |
Adult size pull-on med |
1,502 |
1,493 |
$71K |
| E0431 |
Portable gaseous 02 |
3,403 |
3,357 |
$70K |
| T4523 |
Adult size brief/diaper lg |
1,169 |
1,155 |
$68K |
| T4522 |
Adult size brief/diaper med |
1,016 |
1,010 |
$66K |
| T4528 |
Adult size pull-on xl |
1,075 |
1,066 |
$62K |
| E0720 |
Tens two lead |
447 |
447 |
$54K |
| E0443 |
Portable 02 contents, gas |
742 |
679 |
$54K |
| T4524 |
Adult size brief/diaper xl |
835 |
823 |
$53K |
| E0562 |
Humidifier heated used w pap |
1,032 |
1,009 |
$46K |
| E0245 |
Tub stool or bench |
609 |
606 |
$30K |
| A6545 |
Grad com non-elastic bk surg |
284 |
206 |
$23K |
| A4335 |
Incontinence supply |
2,447 |
2,408 |
$21K |
| A5500 |
Diab shoe for density insert |
248 |
215 |
$20K |
| A6250 |
Skin seal protect moisturizr |
1,812 |
1,788 |
$19K |
| L3908 |
Who cock-up nonmolde pre ots |
352 |
334 |
$18K |
| L1820 |
Ko elas w/ condyle pads & jo |
217 |
213 |
$17K |
| K0195 |
Elevating whlchair leg rests |
732 |
721 |
$17K |
| E0156 |
Walker seat attachment |
826 |
824 |
$13K |
| T4533 |
Youth size brief/diaper |
265 |
263 |
$13K |
| E0163 |
Commode chair with fixed arm |
175 |
169 |
$12K |
| T4521 |
Adult size brief/diaper sm |
262 |
257 |
$11K |
| E0277 |
Powered pres-redu air mattrs |
37 |
37 |
$10K |
| A4927 |
Non-sterile gloves |
1,334 |
1,325 |
$8K |
| A5512 |
Multi den insert direct form |
203 |
119 |
$7K |
| A7005 |
Nondisposable nebulizer set |
228 |
227 |
$6K |
| L0621 |
Sio flex pelvic/sacr pre ots |
63 |
63 |
$4K |
| T4525 |
Adult size pull-on sm |
103 |
103 |
$4K |
| A7037 |
Pos airway pressure tubing |
218 |
217 |
$4K |
| L4360 |
Pneumat walking boot pre cst |
40 |
40 |
$4K |
| A7035 |
Pos airway press headgear |
154 |
153 |
$3K |
| E0100 |
Cane adjust/fixed with tip |
131 |
131 |
$2K |
| T4530 |
Ped size brief/diaper lg |
26 |
26 |
$2K |
| T4537 |
Reusable underpad bed size |
222 |
219 |
$2K |
| E2395 |
Caster wheel excludes tire |
13 |
12 |
$2K |
| A4595 |
Tens suppl 2 lead per month |
94 |
94 |
$2K |
| A7038 |
Pos airway pressure filter |
121 |
121 |
$1K |
| A7034 |
Nasal application device |
13 |
13 |
$945.05 |
| A7039 |
Filter, non disposable w pap |
57 |
57 |
$475.85 |
| E0114 |
Crutch underarm pair no wood |
12 |
12 |
$285.40 |
| A7015 |
Aerosol mask used w nebulize |
62 |
62 |
$62.71 |