| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A7030 |
Full face mask used with positive airway pressure device, each |
16 |
16 |
$2K |
| A7031 |
Face mask interface, replacement for full face mask, each |
67 |
64 |
$2K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
12 |
12 |
$1K |
| A7035 |
Headgear used with positive airway pressure device |
25 |
25 |
$402.30 |
| A7037 |
Tubing used with positive airway pressure device |
26 |
26 |
$318.78 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
133 |
131 |
$236.05 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
27 |
26 |
$166.71 |