| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
11,285 |
10,657 |
$306K |
| E0431 |
Portable gaseous 02 |
8,824 |
8,351 |
$48K |
| E0570 |
Nebulizer with compression |
4,274 |
4,011 |
$20K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,254 |
1,182 |
$15K |
| K0003 |
Lightweight wheelchair |
812 |
765 |
$7K |
| E0601 |
Cont airway pressure device |
380 |
352 |
$6K |
| K0001 |
Standard wheelchair |
850 |
813 |
$5K |
| A7031 |
Replacement facemask interfa |
283 |
271 |
$4K |
| A7038 |
Pos airway pressure filter |
771 |
746 |
$1K |
| E0562 |
Humidifier heated used w pap |
186 |
163 |
$1K |
| A7030 |
Cpap full face mask |
12 |
12 |
$368.93 |
| A7035 |
Pos airway press headgear |
24 |
24 |
$192.01 |
| A4604 |
Tubing with heating element |
12 |
12 |
$148.63 |
| A7003 |
Nebulizer administration set |
71 |
68 |
$70.47 |
| A7013 |
Disposable compressor filter |
75 |
75 |
$24.62 |
| A7015 |
Aerosol mask used w nebulize |
35 |
34 |
$24.32 |