| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
6,700 |
5,732 |
$401K |
| B4035 |
Enteral feed supp pump per d |
567 |
462 |
$92K |
| E0431 |
Portable gaseous 02 |
6,208 |
5,347 |
$72K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,554 |
1,416 |
$59K |
| E0619 |
Apnea monitor w recorder |
432 |
414 |
$55K |
| K0001 |
Standard wheelchair |
5,723 |
4,705 |
$50K |
| E0570 |
Nebulizer with compression |
1,442 |
1,163 |
$40K |
| E0143 |
Walker folding wheeled w/o s |
882 |
770 |
$31K |
| E0630 |
Patient lift hydraulic |
527 |
467 |
$17K |
| K0195 |
Elevating whlchair leg rests |
3,327 |
2,814 |
$15K |
| E0255 |
Hospital bed var ht w/ mattr |
1,316 |
894 |
$9K |
| E0163 |
Commode chair with fixed arm |
177 |
127 |
$2K |
| A6402 |
Sterile gauze <= 16 sq in |
209 |
198 |
$2K |
| E0240 |
Bath/shower chair |
52 |
37 |
$2K |
| A4322 |
Irrigation syringe |
360 |
336 |
$2K |
| L3040 |
Ft arch suprt premold longit |
34 |
17 |
$2K |
| L0642 |
Lo sag ri an/pos pnl pre ots |
13 |
13 |
$2K |
| A4556 |
Electrodes, pair |
15 |
12 |
$1K |
| L3216 |
Orthoped ladies shoes dpth i |
24 |
12 |
$1K |
| A7000 |
Disposable canister for pump |
25 |
24 |
$342.82 |
| B4034 |
Enter feed supkit syr by day |
15 |
13 |
$243.02 |
| E0601 |
Cont airway pressure device |
12 |
12 |
$211.76 |
| E0443 |
Portable 02 contents, gas |
165 |
78 |
$208.55 |
| A7003 |
Nebulizer administration set |
191 |
174 |
$194.39 |
| A4450 |
Non-waterproof tape |
77 |
72 |
$158.64 |
| E1226 |
Manual fully reclining back |
17 |
12 |
$47.16 |
| A7002 |
Tubing used w suction pump |
13 |
12 |
$33.75 |