| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
4,070 |
3,090 |
$131K |
| E0601 |
Cont airway pressure device |
4,663 |
3,720 |
$116K |
| A7030 |
Cpap full face mask |
1,380 |
1,058 |
$67K |
| A4604 |
Tubing with heating element |
1,913 |
1,458 |
$35K |
| A7031 |
Replacement facemask interfa |
1,569 |
1,194 |
$34K |
| E0562 |
Humidifier heated used w pap |
4,199 |
3,373 |
$32K |
| E0570 |
Nebulizer with compression |
4,287 |
3,345 |
$25K |
| E0431 |
Portable gaseous 02 |
2,650 |
2,050 |
$20K |
| A7035 |
Pos airway press headgear |
1,041 |
812 |
$9K |
| A7038 |
Pos airway pressure filter |
2,220 |
1,707 |
$6K |
| A7046 |
Repl water chamber, pap dev |
413 |
318 |
$3K |
| A7005 |
Nondisposable nebulizer set |
393 |
323 |
$2K |
| A7034 |
Nasal application device |
79 |
59 |
$2K |
| A7032 |
Replacement nasal cushion |
78 |
56 |
$1K |
| A5500 |
Diab shoe for density insert |
14 |
13 |
$438.61 |
| A5512 |
Multi den insert direct form |
14 |
13 |
$421.56 |
| J7613 |
Albuterol non-comp unit |
14 |
12 |
$41.28 |
| 91322 |
|
12 |
12 |
$0.00 |
| 90694 |
|
27 |
27 |
$0.00 |
| K1034 |
Covid test self-admn/collect |
178 |
176 |
$0.00 |
| 0064A |
|
121 |
119 |
$0.00 |
| 0011A |
|
27 |
27 |
$0.00 |
| 90674 |
|
62 |
62 |
$0.00 |
| 0012A |
|
16 |
16 |
$0.00 |
| G0008 |
Admin influenza virus vac |
143 |
143 |
$0.00 |
| Q0513 |
Disp fee inhal drugs/30 days |
29 |
26 |
$0.00 |
| 90480 |
|
12 |
12 |
$0.00 |