| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
9,374 |
7,892 |
$487K |
| E0431 |
Portable gaseous 02 |
6,970 |
5,895 |
$83K |
| A7030 |
Cpap full face mask |
790 |
705 |
$61K |
| E0601 |
Cont airway pressure device |
1,386 |
1,162 |
$59K |
| A7031 |
Replacement facemask interfa |
536 |
497 |
$27K |
| E0470 |
Rad w/o backup non-inv intfc |
204 |
173 |
$21K |
| E0261 |
Hosp bed semi-electr w/o mat |
809 |
506 |
$20K |
| E0562 |
Humidifier heated used w pap |
163 |
115 |
$16K |
| A7037 |
Pos airway pressure tubing |
740 |
673 |
$11K |
| A7038 |
Pos airway pressure filter |
1,501 |
1,348 |
$11K |
| A7035 |
Pos airway press headgear |
708 |
630 |
$11K |
| A6402 |
Sterile gauze <= 16 sq in |
344 |
244 |
$10K |
| K0001 |
Standard wheelchair |
416 |
309 |
$8K |
| A7034 |
Nasal application device |
154 |
147 |
$7K |
| A6212 |
Foam drg <=16 sq in w/border |
60 |
52 |
$6K |
| A6021 |
Collagen dressing <=16 sq in |
23 |
14 |
$4K |
| A4604 |
Tubing with heating element |
86 |
81 |
$3K |
| A6446 |
Conform band s w>=3" <5"/yd |
218 |
153 |
$2K |
| A7046 |
Repl water chamber, pap dev |
254 |
239 |
$2K |
| A6196 |
Alginate dressing <=16 sq in |
18 |
12 |
$2K |
| E0570 |
Nebulizer with compression |
183 |
142 |
$1K |
| K0003 |
Lightweight wheelchair |
115 |
81 |
$1K |
| A6251 |
Absorpt drg <=16 sq in w/o b |
44 |
26 |
$1K |
| A7032 |
Replacement nasal cushion |
13 |
12 |
$991.69 |
| A4452 |
Waterproof tape |
35 |
25 |
$541.07 |
| A4450 |
Non-waterproof tape |
136 |
99 |
$409.23 |
| A7039 |
Filter, non disposable w pap |
45 |
42 |
$241.92 |