| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
3,025 |
2,605 |
$326K |
| A4554 |
Disposable underpads |
5,798 |
5,015 |
$251K |
| E1390 |
Oxygen concentrator |
3,818 |
2,636 |
$200K |
| T4526 |
Adult size pull-on med |
2,078 |
1,886 |
$179K |
| T4528 |
Adult size pull-on xl |
1,649 |
1,563 |
$163K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
2,012 |
1,622 |
$152K |
| A7030 |
Cpap full face mask |
2,258 |
1,504 |
$113K |
| E0601 |
Cont airway pressure device |
4,428 |
2,768 |
$111K |
| E0570 |
Nebulizer with compression |
3,011 |
1,902 |
$55K |
| K0738 |
Portable gas oxygen system |
3,005 |
2,072 |
$44K |
| A7037 |
Pos airway pressure tubing |
2,668 |
1,760 |
$27K |
| T4532 |
Ped size pull-on lg |
166 |
148 |
$22K |
| A4927 |
Non-sterile gloves |
1,051 |
978 |
$20K |
| A7035 |
Pos airway press headgear |
1,635 |
1,100 |
$18K |
| A4670 |
Automatic bp monitor, dial |
185 |
152 |
$8K |
| T2025 |
Waiver service, nos |
191 |
186 |
$8K |
| A7038 |
Pos airway pressure filter |
3,558 |
2,333 |
$8K |
| K0001 |
Standard wheelchair |
802 |
481 |
$7K |
| A4335 |
Incontinence supply |
394 |
376 |
$4K |
| E0260 |
Hosp bed semi-electr w/ matt |
54 |
36 |
$3K |
| A7005 |
Nondisposable nebulizer set |
110 |
88 |
$2K |
| E0973 |
W/ch access det adj armrest |
78 |
25 |
$2K |
| A7031 |
Replacement facemask interfa |
39 |
24 |
$547.77 |
| A7015 |
Aerosol mask used w nebulize |
25 |
19 |
$24.54 |