| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult size pull-on xl |
1,562 |
1,427 |
$207K |
| E1390 |
Oxygen concentrator |
4,120 |
3,887 |
$158K |
| T4526 |
Adult size pull-on med |
1,016 |
928 |
$129K |
| T4527 |
Adult size pull-on lg |
986 |
846 |
$112K |
| T4541 |
Large disposable underpad |
1,531 |
1,471 |
$108K |
| A4927 |
Non-sterile gloves |
2,744 |
2,471 |
$77K |
| A7031 |
Replacement facemask interfa |
2,185 |
2,020 |
$66K |
| A7030 |
Cpap full face mask |
1,091 |
1,025 |
$66K |
| T4535 |
Disposable liner/shield/pad |
2,170 |
2,000 |
$63K |
| B4150 |
Ef complet w/intact nutrient |
449 |
373 |
$42K |
| A7032 |
Replacement nasal cushion |
751 |
690 |
$42K |
| E0601 |
Cont airway pressure device |
1,642 |
1,541 |
$38K |
| A4604 |
Tubing with heating element |
656 |
606 |
$32K |
| E0431 |
Portable gaseous 02 |
1,958 |
1,840 |
$17K |
| K0003 |
Lightweight wheelchair |
660 |
611 |
$15K |
| A7038 |
Pos airway pressure filter |
3,252 |
3,070 |
$14K |
| E0570 |
Nebulizer with compression |
185 |
184 |
$10K |
| A7035 |
Pos airway press headgear |
594 |
548 |
$8K |
| A4335 |
Incontinence supply |
2,198 |
1,994 |
$8K |
| T4537 |
Reusable underpad bed size |
104 |
98 |
$7K |
| A7034 |
Nasal application device |
168 |
150 |
$6K |
| A7037 |
Pos airway pressure tubing |
414 |
382 |
$5K |
| A7046 |
Repl water chamber, pap dev |
469 |
425 |
$5K |
| T4522 |
Adult size brief/diaper med |
55 |
50 |
$5K |
| B4154 |
Ef spec metabolic noninherit |
17 |
13 |
$3K |
| A7005 |
Nondisposable nebulizer set |
96 |
95 |
$3K |
| A7033 |
Replacement nasal pillows |
33 |
33 |
$2K |
| A6250 |
Skin seal protect moisturizr |
343 |
286 |
$728.27 |
| K0001 |
Standard wheelchair |
102 |
75 |
$161.08 |