| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
2,689 |
1,566 |
$53K |
| T4524 |
Adult size brief/diaper xl |
347 |
253 |
$40K |
| T4523 |
Adult size brief/diaper lg |
209 |
166 |
$27K |
| K0001 |
Standard wheelchair |
2,186 |
1,347 |
$14K |
| E0261 |
Hosp bed semi-electr w/o mat |
789 |
545 |
$12K |
| E0601 |
Cont airway pressure device |
1,076 |
550 |
$11K |
| E0570 |
Nebulizer with compression |
802 |
432 |
$8K |
| A7038 |
Pos airway pressure filter |
751 |
428 |
$1K |
| A7037 |
Pos airway pressure tubing |
257 |
171 |
$908.03 |
| E0165 |
Commode chair with detacharm |
294 |
178 |
$847.83 |
| A4554 |
Disposable underpads |
14 |
12 |
$797.61 |
| A7035 |
Pos airway press headgear |
99 |
70 |
$711.84 |
| E0431 |
Portable gaseous 02 |
273 |
124 |
$273.98 |
| A7034 |
Nasal application device |
17 |
12 |
$194.21 |
| A7032 |
Replacement nasal cushion |
38 |
25 |
$149.84 |
| A7031 |
Replacement facemask interfa |
24 |
12 |
$128.48 |
| A7039 |
Filter, non disposable w pap |
123 |
72 |
$97.00 |