| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
8,654 |
6,256 |
$414K |
| B4150 |
Ef complet w/intact nutrient |
3,183 |
2,144 |
$195K |
| E0601 |
Cont airway pressure device |
5,194 |
3,853 |
$176K |
| E0570 |
Nebulizer with compression |
5,364 |
4,269 |
$159K |
| B4154 |
Ef spec metabolic noninherit |
1,779 |
1,134 |
$124K |
| A4554 |
Disposable underpads |
4,253 |
2,813 |
$121K |
| A7030 |
Cpap full face mask |
1,547 |
1,195 |
$107K |
| E0562 |
Humidifier heated used w pap |
4,990 |
3,826 |
$56K |
| T4527 |
Adult size pull-on lg |
779 |
647 |
$51K |
| E0431 |
Portable gaseous 02 |
5,402 |
3,839 |
$42K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,397 |
933 |
$36K |
| A7035 |
Pos airway press headgear |
2,297 |
1,766 |
$31K |
| A4927 |
Non-sterile gloves |
2,145 |
1,206 |
$26K |
| A7031 |
Replacement facemask interfa |
1,329 |
977 |
$26K |
| A7037 |
Pos airway pressure tubing |
1,157 |
958 |
$25K |
| T2025 |
Waiver service, nos |
519 |
465 |
$18K |
| E1028 |
W/c manual swingaway |
633 |
422 |
$16K |
| K0001 |
Standard wheelchair |
1,357 |
964 |
$15K |
| K0823 |
Pwc gp 2 std cap chair |
318 |
258 |
$14K |
| S5161 |
Emer rspns sys serv permonth |
592 |
503 |
$12K |
| T4528 |
Adult size pull-on xl |
156 |
132 |
$9K |
| T4535 |
Disposable liner/shield/pad |
406 |
279 |
$8K |
| A7038 |
Pos airway pressure filter |
2,566 |
1,991 |
$5K |
| A7034 |
Nasal application device |
113 |
94 |
$4K |
| E1392 |
Portable oxygen concentrator |
302 |
225 |
$4K |
| A4604 |
Tubing with heating element |
605 |
445 |
$3K |
| A4627 |
Spacer bag/reservoir |
72 |
56 |
$2K |
| E0143 |
Walker folding wheeled w/o s |
14 |
14 |
$833.59 |
| A7039 |
Filter, non disposable w pap |
76 |
57 |
$356.06 |
| E0424 |
Stationary compressed gas 02 |
36 |
21 |
$278.14 |
| K0003 |
Lightweight wheelchair |
20 |
12 |
$220.91 |
| A7003 |
Nebulizer administration set |
49 |
48 |
$121.52 |
| A7046 |
Repl water chamber, pap dev |
65 |
38 |
$91.62 |
| A7015 |
Aerosol mask used w nebulize |
49 |
48 |
$85.81 |