| Code | Description | Claims | Beneficiaries | Total Paid |
| E1390 |
Oxygen concentrator |
470 |
301 |
$15K |
| E0601 |
Cont airway pressure device |
101 |
69 |
$6K |
| A4604 |
Tubing with heating element |
113 |
100 |
$3K |
| K0001 |
Standard wheelchair |
204 |
150 |
$3K |
| E0431 |
Portable gaseous 02 |
303 |
191 |
$2K |
| E0260 |
Hosp bed semi-electr w/ matt |
93 |
54 |
$2K |
| E0570 |
Nebulizer with compression |
31 |
28 |
$1K |
| A7035 |
Pos airway press headgear |
88 |
78 |
$1K |
| A7030 |
Cpap full face mask |
12 |
12 |
$1K |
| A7031 |
Replacement facemask interfa |
14 |
13 |
$402.27 |
| A7038 |
Pos airway pressure filter |
127 |
101 |
$212.79 |
| A7046 |
Repl water chamber, pap dev |
13 |
13 |
$160.59 |
| K0195 |
Elevating whlchair leg rests |
28 |
25 |
$115.66 |