| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4543 |
Adult disp brief/diap abv xl |
1,499 |
1,357 |
$303K |
| T4527 |
Adult size pull-on lg |
3,946 |
3,459 |
$297K |
| T4535 |
Disposable liner/shield/pad |
6,727 |
5,819 |
$278K |
| T4528 |
Adult size pull-on xl |
3,132 |
2,780 |
$257K |
| T4526 |
Adult size pull-on med |
3,366 |
2,999 |
$219K |
| T4541 |
Large disposable underpad |
6,384 |
5,914 |
$207K |
| B4150 |
Ef complet w/intact nutrient |
2,138 |
1,884 |
$187K |
| A4927 |
Non-sterile gloves |
4,845 |
4,532 |
$72K |
| E1390 |
Oxygen concentrator |
2,364 |
2,233 |
$61K |
| B4154 |
Ef spec metabolic noninherit |
427 |
371 |
$52K |
| E0601 |
Cont airway pressure device |
1,432 |
1,367 |
$41K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,434 |
1,385 |
$40K |
| T4523 |
Adult size brief/diaper lg |
306 |
299 |
$30K |
| K0738 |
Portable gas oxygen system |
1,314 |
1,259 |
$22K |
| K0001 |
Standard wheelchair |
623 |
598 |
$12K |
| A7031 |
Replacement facemask interfa |
1,020 |
954 |
$11K |
| T4537 |
Reusable underpad bed size |
64 |
55 |
$6K |
| A7037 |
Pos airway pressure tubing |
827 |
763 |
$6K |
| A7035 |
Pos airway press headgear |
411 |
388 |
$4K |
| A7038 |
Pos airway pressure filter |
2,557 |
2,277 |
$4K |
| B4152 |
Ef calorie dense>/=1.5kcal |
28 |
24 |
$3K |
| A7030 |
Cpap full face mask |
76 |
69 |
$3K |
| T4524 |
Adult size brief/diaper xl |
27 |
24 |
$2K |
| E1038 |
Transport chair pt wt<=300lb |
13 |
12 |
$206.46 |
| A9270 |
Non-covered item or service |
14 |
13 |
$0.00 |