| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A7031 |
Replacement facemask interfa |
2,766 |
2,430 |
$69K |
| E0601 |
Cont airway pressure device |
678 |
567 |
$53K |
| A7030 |
Cpap full face mask |
607 |
534 |
$45K |
| K0003 |
Lightweight wheelchair |
1,188 |
1,165 |
$30K |
| A4604 |
Tubing with heating element |
1,309 |
1,126 |
$29K |
| A7038 |
Pos airway pressure filter |
5,549 |
4,704 |
$19K |
| A7035 |
Pos airway press headgear |
1,321 |
1,134 |
$17K |
| A7032 |
Replacement nasal cushion |
1,220 |
1,027 |
$10K |
| E0570 |
Nebulizer with compression |
62 |
62 |
$4K |
| A7034 |
Nasal application device |
173 |
137 |
$4K |
| A7046 |
Repl water chamber, pap dev |
418 |
346 |
$2K |
| A7033 |
Replacement nasal pillows |
473 |
352 |
$2K |
| L0630 |
Lso r post pnl sj-t9 pre cst |
12 |
12 |
$1K |
| E0470 |
Rad w/o backup non-inv intfc |
14 |
12 |
$613.10 |
| A7005 |
Nondisposable nebulizer set |
21 |
21 |
$588.73 |
| A4927 |
Non-sterile gloves |
44 |
43 |
$432.74 |
| A7013 |
Disposable compressor filter |
21 |
20 |
$25.76 |
| A7003 |
Nebulizer administration set |
21 |
21 |
$0.00 |
| A7045 |
Repl exhalation port for pap |
12 |
12 |
$0.00 |