| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
10,524 |
10,096 |
$793K |
| E0601 |
Cont airway pressure device |
4,588 |
4,477 |
$250K |
| A7030 |
Cpap full face mask |
2,334 |
2,295 |
$243K |
| E0570 |
Nebulizer with compression |
5,918 |
5,691 |
$218K |
| A7031 |
Replacement facemask interfa |
3,849 |
3,758 |
$186K |
| E0431 |
Portable gaseous 02 |
7,064 |
6,826 |
$93K |
| E0562 |
Humidifier heated used w pap |
5,243 |
5,131 |
$83K |
| A7037 |
Pos airway pressure tubing |
3,744 |
3,683 |
$78K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,436 |
1,325 |
$73K |
| A7035 |
Pos airway press headgear |
2,614 |
2,575 |
$50K |
| A7034 |
Nasal application device |
798 |
790 |
$50K |
| A7038 |
Pos airway pressure filter |
6,783 |
6,650 |
$47K |
| A7032 |
Replacement nasal cushion |
868 |
862 |
$42K |
| E0470 |
Rad w/o backup non-inv intfc |
401 |
393 |
$41K |
| K0001 |
Standard wheelchair |
1,798 |
1,679 |
$35K |
| T4526 |
Adult size pull-on med |
265 |
263 |
$29K |
| E0143 |
Walker folding wheeled w/o s |
471 |
455 |
$24K |
| A7046 |
Repl water chamber, pap dev |
1,543 |
1,520 |
$17K |
| K0738 |
Portable gas oxygen system |
1,038 |
1,005 |
$16K |
| T4535 |
Disposable liner/shield/pad |
208 |
207 |
$15K |
| T4541 |
Large disposable underpad |
227 |
226 |
$11K |
| A4627 |
Spacer bag/reservoir |
554 |
540 |
$10K |
| A7033 |
Replacement nasal pillows |
233 |
233 |
$7K |
| T4527 |
Adult size pull-on lg |
43 |
43 |
$6K |
| A7003 |
Nebulizer administration set |
1,765 |
1,725 |
$5K |
| K0195 |
Elevating whlchair leg rests |
1,057 |
966 |
$5K |
| L4387 |
Non-pneum walk boot pre ots |
40 |
36 |
$4K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
243 |
225 |
$3K |
| K0007 |
Extra heavy duty wheelchair |
28 |
24 |
$2K |
| T4523 |
Adult size brief/diaper lg |
12 |
12 |
$1K |
| T4528 |
Adult size pull-on xl |
12 |
12 |
$1K |
| B4152 |
Ef calorie dense>/=1.5kcal |
32 |
13 |
$898.47 |
| A4604 |
Tubing with heating element |
14 |
14 |
$660.16 |
| B4035 |
Enteral feed supp pump per d |
55 |
25 |
$349.67 |
| A7039 |
Filter, non disposable w pap |
41 |
41 |
$192.69 |