| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
11,382 |
7,568 |
$411K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
7,769 |
5,092 |
$56K |
| A7031 |
Face mask interface, replacement for full face mask, each |
740 |
565 |
$28K |
| A7030 |
Full face mask used with positive airway pressure device, each |
520 |
374 |
$24K |
| E0601 |
Continuous positive airway pressure (cpap) device |
302 |
219 |
$10K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,234 |
1,708 |
$10K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
809 |
547 |
$7K |
| E0570 |
Nebulizer, with compressor |
1,492 |
1,038 |
$6K |
| A7037 |
Tubing used with positive airway pressure device |
644 |
444 |
$5K |
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
32 |
26 |
$4K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
95 |
77 |
$4K |
| A7035 |
Headgear used with positive airway pressure device |
313 |
234 |
$3K |
| K0001 |
Standard wheelchair |
232 |
185 |
$1K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
198 |
145 |
$744.91 |