| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
6,385 |
4,926 |
$255K |
| E0601 |
Cont airway pressure device |
4,146 |
3,466 |
$144K |
| A7030 |
Cpap full face mask |
2,452 |
1,943 |
$128K |
| A5513 |
Multi den insert custom mold |
2,223 |
952 |
$102K |
| E0470 |
Rad w/o backup non-inv intfc |
979 |
828 |
$76K |
| A5500 |
Diab shoe for density insert |
2,340 |
1,014 |
$63K |
| E0562 |
Humidifier heated used w pap |
5,207 |
4,292 |
$52K |
| A7031 |
Replacement facemask interfa |
2,153 |
1,711 |
$51K |
| E0431 |
Portable gaseous 02 |
3,795 |
2,862 |
$29K |
| E0570 |
Nebulizer with compression |
1,957 |
1,501 |
$27K |
| A7037 |
Pos airway pressure tubing |
3,231 |
2,556 |
$27K |
| A7035 |
Pos airway press headgear |
2,252 |
1,780 |
$24K |
| A7034 |
Nasal application device |
474 |
398 |
$17K |
| A7038 |
Pos airway pressure filter |
3,521 |
2,779 |
$11K |
| E1392 |
Portable oxygen concentrator |
341 |
323 |
$8K |
| A7039 |
Filter, non disposable w pap |
1,782 |
1,396 |
$7K |
| E1130 |
Whlchr stand fxd arm ft rest |
269 |
261 |
$6K |
| A7046 |
Repl water chamber, pap dev |
693 |
563 |
$5K |
| E0250 |
Hosp bed fixed ht w/ mattres |
103 |
74 |
$2K |
| E0260 |
Hosp bed semi-electr w/ matt |
78 |
61 |
$844.25 |