| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
2,285 |
2,284 |
$93K |
| E0570 |
Nebulizer with compression |
1,441 |
1,437 |
$60K |
| T4535 |
Disposable liner/shield/pad |
817 |
807 |
$55K |
| T4527 |
Adult size pull-on lg |
446 |
443 |
$45K |
| T4528 |
Adult size pull-on xl |
326 |
326 |
$31K |
| K0001 |
Standard wheelchair |
848 |
848 |
$15K |
| E0431 |
Portable gaseous 02 |
1,840 |
1,839 |
$13K |
| E0601 |
Cont airway pressure device |
357 |
357 |
$13K |
| T4541 |
Large disposable underpad |
435 |
434 |
$12K |
| E0562 |
Humidifier heated used w pap |
909 |
908 |
$9K |
| A7030 |
Cpap full face mask |
69 |
69 |
$7K |
| S5161 |
Emer rspns sys serv permonth |
136 |
135 |
$5K |
| E0470 |
Rad w/o backup non-inv intfc |
40 |
40 |
$3K |
| E0118 |
Crutch substitute |
30 |
30 |
$3K |
| E0260 |
Hosp bed semi-electr w/ matt |
103 |
103 |
$2K |
| A7038 |
Pos airway pressure filter |
352 |
350 |
$637.87 |
| A7037 |
Pos airway pressure tubing |
13 |
13 |
$271.53 |