| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
1,802 |
1,554 |
$250K |
| T4528 |
Adult size pull-on xl |
1,424 |
1,214 |
$197K |
| A4554 |
Disposable underpads |
3,873 |
3,260 |
$194K |
| E1390 |
Oxygen concentrator |
3,326 |
2,435 |
$154K |
| T4526 |
Adult size pull-on med |
918 |
818 |
$119K |
| E0570 |
Nebulizer with compression |
3,547 |
2,608 |
$51K |
| E0431 |
Portable gaseous 02 |
3,119 |
2,315 |
$26K |
| E0601 |
Cont airway pressure device |
668 |
540 |
$25K |
| E0260 |
Hosp bed semi-electr w/ matt |
664 |
455 |
$21K |
| K0001 |
Standard wheelchair |
1,341 |
915 |
$20K |
| T4522 |
Adult size brief/diaper med |
109 |
101 |
$15K |
| A4253 |
Blood glucose/reagent strips |
1,692 |
1,224 |
$5K |
| T4534 |
Youth size pull-on |
28 |
26 |
$3K |
| T4544 |
Adlt disp und/pull on abv xl |
12 |
12 |
$3K |
| A7035 |
Pos airway press headgear |
44 |
39 |
$734.00 |
| A7037 |
Pos airway pressure tubing |
31 |
27 |
$492.91 |
| A7003 |
Nebulizer administration set |
310 |
250 |
$424.03 |
| E0114 |
Crutch underarm pair no wood |
13 |
12 |
$394.61 |
| A4259 |
Lancets per box |
1,357 |
981 |
$332.88 |
| Q0513 |
Disp fee inhal drugs/30 days |
43 |
26 |
$292.84 |