| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0601 |
Cont airway pressure device |
422 |
418 |
$88K |
| E0604 |
Hosp grade elec breast pump |
740 |
730 |
$35K |
| S9999 |
Sales tax |
2,577 |
2,426 |
$32K |
| A7034 |
Nasal application device |
234 |
232 |
$25K |
| A4604 |
Tubing with heating element |
305 |
302 |
$18K |
| A7005 |
Nondisposable nebulizer set |
455 |
454 |
$15K |
| A7038 |
Pos airway pressure filter |
741 |
730 |
$12K |
| A7035 |
Pos airway press headgear |
300 |
297 |
$11K |
| E0570 |
Nebulizer with compression |
38 |
37 |
$5K |
| A7039 |
Filter, non disposable w pap |
302 |
299 |
$4K |
| E0143 |
Walker folding wheeled w/o s |
39 |
38 |
$3K |
| E0562 |
Humidifier heated used w pap |
12 |
12 |
$3K |
| A7015 |
Aerosol mask used w nebulize |
259 |
256 |
$520.56 |
| A7032 |
Replacement nasal cushion |
12 |
12 |
$446.51 |
| A7013 |
Disposable compressor filter |
25 |
25 |
$39.16 |