| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,948 |
2,232 |
$70K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,971 |
2,256 |
$65K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,935 |
1,471 |
$32K |
| A7030 |
Full face mask used with positive airway pressure device, each |
655 |
441 |
$30K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
95 |
87 |
$28K |
| A4335 |
Incontinence supply; miscellaneous |
155 |
148 |
$23K |
| A7035 |
Headgear used with positive airway pressure device |
1,372 |
997 |
$14K |
| A7037 |
Tubing used with positive airway pressure device |
1,219 |
922 |
$13K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
330 |
225 |
$8K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
409 |
319 |
$7K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,946 |
1,420 |
$5K |
| E1399 |
Durable medical equipment, miscellaneous |
26 |
25 |
$4K |
| E0570 |
Nebulizer, with compressor |
538 |
407 |
$3K |
| E1392 |
Portable oxygen concentrator, rental |
288 |
179 |
$725.82 |
| A4927 |
Gloves, non-sterile, per 100 |
14 |
14 |
$689.78 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
19 |
13 |
$67.98 |
| K0001 |
Standard wheelchair |
49 |
48 |
$42.16 |