| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
4,403 |
3,584 |
$272K |
| E0601 |
Cont airway pressure device |
2,369 |
2,083 |
$123K |
| A7030 |
Cpap full face mask |
1,448 |
1,187 |
$104K |
| E0260 |
Hosp bed semi-electr w/ matt |
3,613 |
2,475 |
$89K |
| A7034 |
Nasal application device |
1,483 |
1,310 |
$81K |
| K0001 |
Standard wheelchair |
5,555 |
4,091 |
$76K |
| A4604 |
Tubing with heating element |
2,437 |
2,046 |
$66K |
| E0630 |
Patient lift hydraulic |
1,620 |
1,099 |
$37K |
| A7031 |
Replacement facemask interfa |
1,254 |
1,028 |
$37K |
| A7032 |
Replacement nasal cushion |
937 |
843 |
$36K |
| A7035 |
Pos airway press headgear |
1,880 |
1,577 |
$31K |
| E0431 |
Portable gaseous 02 |
2,621 |
2,076 |
$30K |
| E0562 |
Humidifier heated used w pap |
300 |
260 |
$29K |
| E0570 |
Nebulizer with compression |
1,494 |
1,075 |
$23K |
| A7038 |
Pos airway pressure filter |
3,297 |
2,831 |
$18K |
| E0143 |
Walker folding wheeled w/o s |
392 |
324 |
$13K |
| A4927 |
Non-sterile gloves |
1,049 |
769 |
$13K |
| A7046 |
Repl water chamber, pap dev |
1,298 |
1,112 |
$12K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
827 |
640 |
$10K |
| K0195 |
Elevating whlchair leg rests |
1,163 |
938 |
$8K |
| E0470 |
Rad w/o backup non-inv intfc |
93 |
75 |
$8K |
| T4541 |
Large disposable underpad |
370 |
330 |
$6K |
| A4670 |
Automatic bp monitor, dial |
91 |
88 |
$4K |
| E1392 |
Portable oxygen concentrator |
296 |
264 |
$4K |
| E0603 |
Electric breast pump |
14 |
13 |
$3K |
| A7039 |
Filter, non disposable w pap |
327 |
284 |
$2K |
| A7000 |
Disposable canister for pump |
108 |
89 |
$2K |
| E0600 |
Suction pump portab hom modl |
104 |
87 |
$2K |
| A7002 |
Tubing used w suction pump |
146 |
125 |
$1K |
| T4526 |
Adult size pull-on med |
15 |
13 |
$1K |
| T4527 |
Adult size pull-on lg |
13 |
12 |
$941.46 |
| E0156 |
Walker seat attachment |
107 |
93 |
$870.87 |
| A4628 |
Oropharyngeal suction cath |
31 |
24 |
$228.07 |
| E0971 |
Wheelchair anti-tipping devi |
89 |
37 |
$94.76 |
| A7003 |
Nebulizer administration set |
44 |
41 |
$76.04 |
| A7014 |
Compressor nondispos filter |
14 |
12 |
$25.35 |