| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
3,915 |
3,373 |
$131K |
| E0570 |
Nebulizer with compression |
2,361 |
2,007 |
$105K |
| A7031 |
Replacement facemask interfa |
3,910 |
3,447 |
$83K |
| E0601 |
Cont airway pressure device |
2,496 |
2,217 |
$73K |
| A7030 |
Cpap full face mask |
955 |
877 |
$43K |
| A4604 |
Tubing with heating element |
1,654 |
1,494 |
$41K |
| E0470 |
Rad w/o backup non-inv intfc |
455 |
401 |
$28K |
| E0562 |
Humidifier heated used w pap |
1,093 |
992 |
$26K |
| A7032 |
Replacement nasal cushion |
1,198 |
1,030 |
$26K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,227 |
1,043 |
$23K |
| A7038 |
Pos airway pressure filter |
8,282 |
7,321 |
$21K |
| E0431 |
Portable gaseous 02 |
2,626 |
2,302 |
$21K |
| A7035 |
Pos airway press headgear |
1,803 |
1,651 |
$21K |
| K0001 |
Standard wheelchair |
1,252 |
1,046 |
$20K |
| A7037 |
Pos airway pressure tubing |
1,384 |
1,223 |
$12K |
| A7034 |
Nasal application device |
331 |
301 |
$11K |
| A7046 |
Repl water chamber, pap dev |
1,098 |
1,002 |
$9K |
| A7039 |
Filter, non disposable w pap |
1,735 |
1,598 |
$7K |
| A7033 |
Replacement nasal pillows |
575 |
486 |
$7K |
| A5512 |
Multi den insert direct form |
170 |
95 |
$5K |
| A5500 |
Diab shoe for density insert |
189 |
107 |
$5K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
57 |
37 |
$5K |
| A4253 |
Blood glucose/reagent strips |
847 |
678 |
$2K |
| E0603 |
Electric breast pump |
14 |
12 |
$2K |
| Q0513 |
Disp fee inhal drugs/30 days |
341 |
302 |
$2K |
| A7003 |
Nebulizer administration set |
1,025 |
935 |
$1K |
| 87426 |
|
873 |
479 |
$1K |
| A7015 |
Aerosol mask used w nebulize |
518 |
472 |
$556.07 |
| A7013 |
Disposable compressor filter |
328 |
295 |
$255.70 |
| 99401 |
|
13 |
13 |
$115.40 |
| A4259 |
Lancets per box |
57 |
50 |
$14.72 |
| 0003A |
|
24 |
24 |
$0.00 |
| 99211 |
|
130 |
75 |
$0.00 |
| 0004A |
|
95 |
94 |
$0.00 |
| 0002A |
|
61 |
60 |
$0.00 |
| 0124A |
|
83 |
81 |
$0.00 |
| 87635 |
|
448 |
135 |
$0.00 |
| 90694 |
|
29 |
29 |
$0.00 |
| K1034 |
Covid test self-admn/collect |
110 |
106 |
$0.00 |
| 0001A |
|
69 |
68 |
$0.00 |
| G0008 |
Admin influenza virus vac |
101 |
99 |
$0.00 |
| 86769 |
|
543 |
161 |
$0.00 |
| 90656 |
|
20 |
20 |
$0.00 |
| 0064A |
|
12 |
12 |
$0.00 |