| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
19,512 |
19,272 |
$1.07M |
| E0466 |
Home vent non-invasive inter |
2,200 |
2,189 |
$864K |
| E0471 |
Rad w/backup non inv intrfc |
2,058 |
2,026 |
$653K |
| T4541 |
Large disposable underpad |
4,833 |
4,798 |
$208K |
| E0601 |
Cont airway pressure device |
4,466 |
4,364 |
$191K |
| T4527 |
Adult size pull-on lg |
2,376 |
2,358 |
$138K |
| E0470 |
Rad w/o backup non-inv intfc |
870 |
851 |
$123K |
| E0431 |
Portable gaseous 02 |
7,642 |
7,529 |
$93K |
| E0562 |
Humidifier heated used w pap |
7,357 |
7,274 |
$93K |
| T4528 |
Adult size pull-on xl |
1,385 |
1,373 |
$92K |
| T4535 |
Disposable liner/shield/pad |
2,179 |
2,146 |
$92K |
| T4526 |
Adult size pull-on med |
1,450 |
1,439 |
$79K |
| K0001 |
Standard wheelchair |
3,560 |
3,456 |
$77K |
| A7030 |
Cpap full face mask |
1,102 |
1,097 |
$57K |
| A4604 |
Tubing with heating element |
2,133 |
2,118 |
$49K |
| E1392 |
Portable oxygen concentrator |
2,281 |
2,260 |
$43K |
| E0570 |
Nebulizer with compression |
4,878 |
4,745 |
$35K |
| K0738 |
Portable gas oxygen system |
1,434 |
1,417 |
$31K |
| A7034 |
Nasal application device |
797 |
795 |
$25K |
| E0143 |
Walker folding wheeled w/o s |
701 |
693 |
$20K |
| S9999 |
Sales tax |
6,151 |
5,968 |
$19K |
| A7031 |
Replacement facemask interfa |
717 |
714 |
$17K |
| A7038 |
Pos airway pressure filter |
3,628 |
3,608 |
$12K |
| A7046 |
Repl water chamber, pap dev |
1,158 |
1,147 |
$11K |
| A7032 |
Replacement nasal cushion |
422 |
421 |
$10K |
| E0295 |
Hosp bed semi-elect w/o matt |
177 |
177 |
$10K |
| A7035 |
Pos airway press headgear |
1,036 |
1,033 |
$9K |
| E0260 |
Hosp bed semi-electr w/ matt |
514 |
511 |
$5K |
| A7039 |
Filter, non disposable w pap |
1,715 |
1,711 |
$5K |
| A7005 |
Nondisposable nebulizer set |
423 |
421 |
$3K |
| A7033 |
Replacement nasal pillows |
47 |
47 |
$1K |
| A7037 |
Pos airway pressure tubing |
176 |
176 |
$797.83 |
| A7036 |
Pos airway press chinstrap |
41 |
41 |
$337.38 |