| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
13,042 |
12,369 |
$722K |
| T4535 |
Disposable liner/shield/pad |
9,530 |
9,019 |
$699K |
| T4527 |
Adult size pull-on lg |
5,532 |
5,190 |
$532K |
| T4526 |
Adult size pull-on med |
4,692 |
4,510 |
$446K |
| T4528 |
Adult size pull-on xl |
4,338 |
4,166 |
$426K |
| A4239 |
Non-adju cgm supply allow |
2,143 |
1,620 |
$265K |
| E0240 |
Bath/shower chair |
966 |
828 |
$188K |
| T4544 |
Adlt disp und/pull on abv xl |
1,882 |
1,763 |
$179K |
| A4927 |
Non-sterile gloves |
19,904 |
18,776 |
$130K |
| E0601 |
Cont airway pressure device |
4,113 |
3,117 |
$124K |
| E0245 |
Tub stool or bench |
201 |
175 |
$66K |
| A4253 |
Blood glucose/reagent strips |
1,076 |
928 |
$64K |
| E1390 |
Oxygen concentrator |
2,300 |
1,595 |
$58K |
| E0260 |
Hosp bed semi-electr w/ matt |
2,148 |
1,539 |
$55K |
| E0246 |
Transfer tub rail attachment |
951 |
611 |
$54K |
| E0241 |
Bath tub wall rail |
966 |
849 |
$35K |
| K0553 |
Ther cgm supply allowance |
299 |
211 |
$26K |
| K0001 |
Standard wheelchair |
2,608 |
1,860 |
$17K |
| E0940 |
Trapeze bar free standing |
2,004 |
1,439 |
$15K |
| T4525 |
Adult size pull-on sm |
133 |
130 |
$12K |
| E2103 |
Non-adju cgm receiver/mon |
123 |
79 |
$12K |
| A5514 |
Mult den insert dir carv/cam |
341 |
113 |
$10K |
| A4259 |
Lancets per box |
777 |
685 |
$10K |
| A5500 |
Diab shoe for density insert |
299 |
111 |
$8K |
| E0163 |
Commode chair with fixed arm |
169 |
142 |
$7K |
| E0570 |
Nebulizer with compression |
799 |
538 |
$6K |
| E0431 |
Portable gaseous 02 |
898 |
632 |
$5K |
| E0143 |
Walker folding wheeled w/o s |
86 |
65 |
$4K |
| T4523 |
Adult size brief/diaper lg |
53 |
49 |
$4K |
| A4351 |
Straight tip urine catheter |
29 |
24 |
$4K |
| E0630 |
Patient lift hydraulic |
166 |
144 |
$4K |
| A7038 |
Pos airway pressure filter |
560 |
448 |
$4K |
| A4604 |
Tubing with heating element |
305 |
218 |
$3K |
| A4256 |
Calibrator solution/chips |
445 |
402 |
$2K |
| A7034 |
Nasal application device |
130 |
102 |
$2K |
| T4522 |
Adult size brief/diaper med |
14 |
13 |
$1K |
| K0554 |
Ther cgm receiver/monitor |
19 |
13 |
$1K |
| A7032 |
Replacement nasal cushion |
15 |
13 |
$798.33 |
| E0149 |
Heavy duty wheeled walker |
62 |
37 |
$703.11 |
| E0910 |
Trapeze bar attached to bed |
357 |
214 |
$605.40 |
| E0156 |
Walker seat attachment |
168 |
105 |
$588.95 |
| E0305 |
Rails bed side half length |
201 |
108 |
$282.25 |
| A7037 |
Pos airway pressure tubing |
14 |
13 |
$132.24 |
| A7035 |
Pos airway press headgear |
53 |
39 |
$126.98 |
| A7046 |
Repl water chamber, pap dev |
39 |
25 |
$125.75 |
| Z2077 |
|
19 |
16 |
$0.00 |