| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
6,768 |
6,423 |
$220K |
| X1939 |
|
2,100 |
2,091 |
$137K |
| T4527 |
Adult size pull-on lg |
2,191 |
2,143 |
$114K |
| T5999 |
Supply, nos |
11,743 |
10,524 |
$92K |
| T4528 |
Adult size pull-on xl |
1,239 |
1,195 |
$84K |
| T4526 |
Adult size pull-on med |
1,426 |
1,364 |
$67K |
| E1390 |
Oxygen concentrator |
1,356 |
936 |
$43K |
| T4523 |
Adult size brief/diaper lg |
561 |
458 |
$35K |
| E0570 |
Nebulizer with compression |
1,421 |
1,002 |
$25K |
| T4524 |
Adult size brief/diaper xl |
176 |
169 |
$16K |
| T4535 |
Disposable liner/shield/pad |
412 |
406 |
$13K |
| E0601 |
Cont airway pressure device |
372 |
263 |
$13K |
| T2028 |
Special supply, nos waiver |
166 |
155 |
$12K |
| E0431 |
Portable gaseous 02 |
1,236 |
864 |
$8K |
| K0001 |
Standard wheelchair |
335 |
191 |
$5K |
| T4522 |
Adult size brief/diaper med |
28 |
25 |
$2K |
| T4534 |
Youth size pull-on |
13 |
13 |
$2K |
| E0260 |
Hosp bed semi-electr w/ matt |
53 |
24 |
$1K |
| A7003 |
Nebulizer administration set |
186 |
162 |
$389.36 |
| A7015 |
Aerosol mask used w nebulize |
131 |
118 |
$197.68 |
| A7038 |
Pos airway pressure filter |
21 |
13 |
$33.94 |