| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
4,539 |
4,528 |
$426K |
| E0601 |
Cont airway pressure device |
1,432 |
1,426 |
$95K |
| E0431 |
Portable gaseous 02 |
2,532 |
2,530 |
$43K |
| E0570 |
Nebulizer with compression |
1,146 |
1,145 |
$22K |
| E0562 |
Humidifier heated used w pap |
1,342 |
1,342 |
$18K |
| A7038 |
Pos airway pressure filter |
194 |
193 |
$4K |
| A7035 |
Pos airway press headgear |
78 |
78 |
$2K |
| A7046 |
Repl water chamber, pap dev |
131 |
131 |
$1K |
| A7030 |
Cpap full face mask |
12 |
12 |
$1K |
| A7037 |
Pos airway pressure tubing |
40 |
40 |
$912.85 |
| A7031 |
Replacement facemask interfa |
24 |
24 |
$672.66 |
| K0001 |
Standard wheelchair |
12 |
12 |
$316.36 |