| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,203 |
2,152 |
$16K |
| K0004 |
High strength, lightweight wheelchair |
162 |
162 |
$4K |
| E1392 |
Portable oxygen concentrator, rental |
1,007 |
994 |
$3K |
| K0001 |
Standard wheelchair |
203 |
199 |
$2K |
| E0601 |
Continuous positive airway pressure (cpap) device |
201 |
200 |
$509.98 |
| K0002 |
Standard hemi (low seat) wheelchair |
249 |
244 |
$484.39 |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
105 |
104 |
$417.60 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
26 |
26 |
$46.30 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
29 |
29 |
$3.95 |
| A7030 |
Full face mask used with positive airway pressure device, each |
12 |
12 |
$3.89 |