| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
6,815 |
6,799 |
$394K |
| K0823 |
Pwc gp 2 std cap chair |
719 |
719 |
$78K |
| E0431 |
Portable gaseous 02 |
5,052 |
5,045 |
$55K |
| E0570 |
Nebulizer with compression |
2,210 |
2,210 |
$51K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,911 |
1,907 |
$50K |
| K0001 |
Standard wheelchair |
1,662 |
1,661 |
$32K |
| T4535 |
Disposable liner/shield/pad |
447 |
440 |
$25K |
| T4541 |
Large disposable underpad |
492 |
475 |
$16K |
| T4527 |
Adult size pull-on lg |
103 |
99 |
$12K |
| E0443 |
Portable 02 contents, gas |
514 |
513 |
$11K |
| T4526 |
Adult size pull-on med |
78 |
75 |
$8K |
| A7003 |
Nebulizer administration set |
598 |
598 |
$2K |
| E0601 |
Cont airway pressure device |
13 |
13 |
$683.68 |
| E0562 |
Humidifier heated used w pap |
25 |
24 |
$658.52 |
| E1392 |
Portable oxygen concentrator |
122 |
121 |
$610.44 |
| A7013 |
Disposable compressor filter |
113 |
113 |
$345.61 |
| A7038 |
Pos airway pressure filter |
241 |
237 |
$279.28 |
| A7015 |
Aerosol mask used w nebulize |
138 |
138 |
$216.34 |
| A7014 |
Compressor nondispos filter |
58 |
58 |
$151.12 |
| E0181 |
Press pad alternating w/ pum |
13 |
13 |
$57.40 |