| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0260 |
Hosp bed semi-electr w/ matt |
3,889 |
2,349 |
$29K |
| K0001 |
Standard wheelchair |
5,721 |
3,543 |
$24K |
| E1390 |
Oxygen concentrator |
1,789 |
1,124 |
$20K |
| E0601 |
Cont airway pressure device |
1,239 |
900 |
$11K |
| K0195 |
Elevating whlchair leg rests |
3,169 |
2,023 |
$3K |
| E0431 |
Portable gaseous 02 |
1,264 |
784 |
$2K |
| E0630 |
Patient lift hydraulic |
292 |
155 |
$1K |
| E0261 |
Hosp bed semi-electr w/o mat |
357 |
210 |
$1K |
| E0570 |
Nebulizer with compression |
103 |
62 |
$239.76 |
| E0255 |
Hospital bed var ht w/ mattr |
29 |
26 |
$229.88 |
| E0143 |
Walker folding wheeled w/o s |
18 |
12 |
$163.40 |
| A7031 |
Replacement facemask interfa |
23 |
15 |
$108.52 |
| E2601 |
Gen w/c cushion wdth < 22 in |
41 |
24 |
$81.60 |
| E0562 |
Humidifier heated used w pap |
316 |
237 |
$78.66 |
| A7030 |
Cpap full face mask |
60 |
41 |
$63.08 |
| A7038 |
Pos airway pressure filter |
417 |
268 |
$47.62 |
| A7035 |
Pos airway press headgear |
14 |
12 |
$0.00 |
| A4604 |
Tubing with heating element |
45 |
28 |
$0.00 |