| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
3,859 |
3,757 |
$297K |
| A7030 |
Cpap full face mask |
1,172 |
1,155 |
$130K |
| E0601 |
Cont airway pressure device |
1,853 |
1,810 |
$101K |
| A4604 |
Tubing with heating element |
2,279 |
2,247 |
$99K |
| T4535 |
Disposable liner/shield/pad |
1,656 |
1,535 |
$86K |
| A7031 |
Replacement facemask interfa |
1,668 |
1,653 |
$74K |
| T2029 |
Special med equip, noswaiver |
620 |
546 |
$70K |
| A7034 |
Nasal application device |
983 |
965 |
$70K |
| T4526 |
Adult size pull-on med |
616 |
576 |
$54K |
| T4527 |
Adult size pull-on lg |
639 |
600 |
$52K |
| T4528 |
Adult size pull-on xl |
322 |
302 |
$41K |
| A7035 |
Pos airway press headgear |
1,680 |
1,656 |
$38K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
357 |
340 |
$22K |
| E0431 |
Portable gaseous 02 |
1,469 |
1,439 |
$19K |
| A7038 |
Pos airway pressure filter |
3,442 |
3,389 |
$19K |
| A6212 |
Foam drg <=16 sq in w/border |
188 |
167 |
$18K |
| A7046 |
Repl water chamber, pap dev |
831 |
821 |
$12K |
| A6446 |
Conform band s w>=3" <5"/yd |
239 |
228 |
$9K |
| A7032 |
Replacement nasal cushion |
241 |
237 |
$9K |
| E0603 |
Electric breast pump |
37 |
36 |
$3K |
| E1392 |
Portable oxygen concentrator |
78 |
77 |
$3K |
| K0738 |
Portable gas oxygen system |
63 |
62 |
$3K |
| K0739 |
Repair/svc dme non-oxygen eq |
77 |
72 |
$2K |
| K0108 |
W/c component-accessory nos |
26 |
12 |
$2K |
| A4452 |
Waterproof tape |
39 |
39 |
$951.58 |
| A6240 |
Hydrocolld drg filler paste |
13 |
13 |
$752.10 |
| K0001 |
Standard wheelchair |
34 |
34 |
$687.99 |
| A6402 |
Sterile gauze <= 16 sq in |
73 |
69 |
$424.46 |
| A4450 |
Non-waterproof tape |
133 |
114 |
$414.84 |
| A7037 |
Pos airway pressure tubing |
26 |
25 |
$0.00 |
| A7039 |
Filter, non disposable w pap |
13 |
13 |
$0.00 |