| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
7,242 |
6,510 |
$161K |
| E0603 |
Electric breast pump |
1,496 |
1,329 |
$151K |
| E0570 |
Nebulizer with compression |
3,524 |
3,091 |
$125K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,848 |
1,632 |
$79K |
| K0823 |
Pwc gp 2 std cap chair |
157 |
126 |
$27K |
| E1392 |
Portable oxygen concentrator |
2,900 |
2,588 |
$22K |
| K0001 |
Standard wheelchair |
2,242 |
1,942 |
$17K |
| K0738 |
Portable gas oxygen system |
1,413 |
1,273 |
$16K |
| K0002 |
Stnd hemi (low seat) whlchr |
1,301 |
1,135 |
$12K |
| E0261 |
Hosp bed semi-electr w/o mat |
1,468 |
1,321 |
$11K |
| E0971 |
Wheelchair anti-tipping devi |
6,268 |
2,878 |
$6K |
| E0601 |
Cont airway pressure device |
1,969 |
1,619 |
$5K |
| K0006 |
Heavy duty wheelchair |
26 |
25 |
$4K |
| E0250 |
Hosp bed fixed ht w/ mattres |
735 |
700 |
$4K |
| E0143 |
Walker folding wheeled w/o s |
208 |
188 |
$3K |
| K0821 |
Pwc gp 2 std port cap chair |
40 |
36 |
$1K |
| E1028 |
W/c manual swingaway |
155 |
127 |
$1K |
| A7031 |
Replacement facemask interfa |
319 |
250 |
$753.04 |
| E0114 |
Crutch underarm pair no wood |
12 |
12 |
$602.52 |
| E0961 |
Wheelchair brake extension |
115 |
51 |
$411.59 |
| K0195 |
Elevating whlchair leg rests |
36 |
25 |
$407.71 |
| E0635 |
Patient lift electric |
482 |
436 |
$395.03 |
| E0277 |
Powered pres-redu air mattrs |
27 |
26 |
$319.47 |
| A7030 |
Cpap full face mask |
289 |
230 |
$298.23 |
| A7004 |
Disposable nebulizer sml vol |
318 |
301 |
$297.89 |
| A7038 |
Pos airway pressure filter |
1,153 |
898 |
$285.35 |
| E0951 |
Loop heel |
119 |
52 |
$265.80 |
| A7035 |
Pos airway press headgear |
360 |
290 |
$249.32 |
| E0431 |
Portable gaseous 02 |
100 |
91 |
$235.82 |
| A4604 |
Tubing with heating element |
195 |
155 |
$165.33 |
| A7046 |
Repl water chamber, pap dev |
275 |
230 |
$85.13 |
| E2601 |
Gen w/c cushion wdth < 22 in |
30 |
24 |
$72.96 |
| A7034 |
Nasal application device |
43 |
37 |
$37.44 |
| A7037 |
Pos airway pressure tubing |
76 |
68 |
$35.17 |
| E0271 |
Mattress innerspring |
15 |
13 |
$16.95 |
| E2611 |
Gen use back cush wdth <22in |
15 |
12 |
$0.00 |
| A9270 |
Non-covered item or service |
16 |
12 |
$0.00 |