| 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 |
674 |
669 |
$36K |
| A7030 |
Full face mask used with positive airway pressure device, each |
94 |
93 |
$6K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
507 |
501 |
$6K |
| A7031 |
Face mask interface, replacement for full face mask, each |
166 |
165 |
$5K |
| E0601 |
Continuous positive airway pressure (cpap) device |
138 |
132 |
$4K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
55 |
55 |
$2K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
437 |
432 |
$2K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
39 |
36 |
$1K |
| A7035 |
Headgear used with positive airway pressure device |
85 |
84 |
$1K |
| A7037 |
Tubing used with positive airway pressure device |
85 |
85 |
$789.88 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
62 |
61 |
$375.32 |
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
13 |
12 |
$326.92 |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
14 |
12 |
$290.07 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
14 |
14 |
$52.90 |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
38 |
38 |
$0.00 |