| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
3,680 |
3,676 |
$329K |
| E1390 |
Oxygen concentrator |
2,488 |
2,461 |
$267K |
| T4535 |
Disposable liner/shield/pad |
4,551 |
4,537 |
$263K |
| T4528 |
Adult size pull-on xl |
2,650 |
2,638 |
$207K |
| T4526 |
Adult size pull-on med |
2,216 |
2,212 |
$190K |
| T4544 |
Adlt disp und/pull on abv xl |
1,080 |
1,078 |
$173K |
| T4541 |
Large disposable underpad |
6,538 |
6,518 |
$156K |
| T4534 |
Youth size pull-on |
1,245 |
1,242 |
$154K |
| T4537 |
Reusable underpad bed size |
3,745 |
3,739 |
$144K |
| E0570 |
Nebulizer with compression |
1,011 |
990 |
$91K |
| T4523 |
Adult size brief/diaper lg |
651 |
649 |
$72K |
| A4927 |
Non-sterile gloves |
2,704 |
2,625 |
$59K |
| T4522 |
Adult size brief/diaper med |
453 |
451 |
$44K |
| K0001 |
Standard wheelchair |
1,009 |
1,003 |
$23K |
| E0431 |
Portable gaseous 02 |
1,285 |
1,269 |
$23K |
| T4525 |
Adult size pull-on sm |
226 |
226 |
$19K |
| A7005 |
Nondisposable nebulizer set |
780 |
775 |
$16K |
| A6530 |
Compression stocking bk18-30 |
85 |
53 |
$6K |
| E0260 |
Hosp bed semi-electr w/ matt |
136 |
131 |
$5K |
| A7031 |
Replacement facemask interfa |
108 |
106 |
$5K |
| A7038 |
Pos airway pressure filter |
598 |
595 |
$3K |
| E0601 |
Cont airway pressure device |
39 |
39 |
$2K |
| A7003 |
Nebulizer administration set |
535 |
530 |
$2K |
| T4524 |
Adult size brief/diaper xl |
12 |
12 |
$990.93 |
| A7035 |
Pos airway press headgear |
45 |
43 |
$772.37 |
| A7013 |
Disposable compressor filter |
539 |
531 |
$646.22 |
| A4627 |
Spacer bag/reservoir |
32 |
32 |
$353.40 |
| A7039 |
Filter, non disposable w pap |
26 |
26 |
$236.64 |
| A7046 |
Repl water chamber, pap dev |
12 |
12 |
$183.73 |
| E1038 |
Transport chair pt wt<=300lb |
12 |
12 |
$103.57 |
| A7015 |
Aerosol mask used w nebulize |
45 |
44 |
$61.57 |