| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/pad |
19,118 |
18,869 |
$955K |
| T4528 |
Adult size pull-on xl |
7,206 |
7,098 |
$798K |
| T4527 |
Adult size pull-on lg |
8,184 |
8,121 |
$720K |
| T4526 |
Adult size pull-on med |
7,140 |
7,064 |
$610K |
| T4541 |
Large disposable underpad |
11,902 |
11,518 |
$388K |
| T4543 |
Adult disp brief/diap abv xl |
2,141 |
2,125 |
$324K |
| E1390 |
Oxygen concentrator |
4,419 |
4,417 |
$302K |
| T1999 |
Noc retail items andsupplies |
968 |
936 |
$160K |
| B4150 |
Ef complet w/intact nutrient |
1,040 |
1,030 |
$132K |
| T4525 |
Adult size pull-on sm |
1,084 |
1,073 |
$69K |
| T4540 |
Reusable underpad chair size |
683 |
681 |
$52K |
| T4537 |
Reusable underpad bed size |
690 |
688 |
$52K |
| T4542 |
Small disposable underpad |
2,755 |
2,717 |
$50K |
| A4927 |
Non-sterile gloves |
1,873 |
1,844 |
$33K |
| K0738 |
Portable gas oxygen system |
1,937 |
1,937 |
$32K |
| E0601 |
Cont airway pressure device |
485 |
481 |
$29K |
| T4544 |
Adlt disp und/pull on abv xl |
187 |
183 |
$27K |
| E0260 |
Hosp bed semi-electr w/ matt |
609 |
609 |
$23K |
| E1399 |
Durable medical equipment mi |
480 |
474 |
$23K |
| E0431 |
Portable gaseous 02 |
1,530 |
1,528 |
$20K |
| S5165 |
Home modifications per serv |
114 |
113 |
$16K |
| E0570 |
Nebulizer with compression |
637 |
637 |
$15K |
| E0562 |
Humidifier heated used w pap |
681 |
679 |
$13K |
| E0240 |
Bath/shower chair |
125 |
125 |
$11K |
| K0001 |
Standard wheelchair |
167 |
167 |
$4K |
| E0246 |
Transfer tub rail attachment |
43 |
43 |
$3K |
| E0244 |
Toilet seat raised |
32 |
32 |
$2K |
| A4335 |
Incontinence supply |
192 |
192 |
$2K |
| A7035 |
Pos airway press headgear |
13 |
13 |
$226.34 |
| A7038 |
Pos airway pressure filter |
12 |
12 |
$58.02 |