| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
27,729 |
27,530 |
$1.91M |
| B4161 |
Ef ped hydrolyzed/amino acid |
1,050 |
1,013 |
$561K |
| E0466 |
Home vent non-invasive inter |
958 |
950 |
$423K |
| E0431 |
Portable gaseous 02 |
15,588 |
15,474 |
$190K |
| A7031 |
Replacement facemask interfa |
2,084 |
2,049 |
$65K |
| A7030 |
Cpap full face mask |
1,555 |
1,547 |
$61K |
| E1392 |
Portable oxygen concentrator |
2,454 |
2,440 |
$60K |
| B4035 |
Enteral feed supp pump per d |
398 |
383 |
$46K |
| E0601 |
Cont airway pressure device |
1,728 |
1,712 |
$44K |
| A7032 |
Replacement nasal cushion |
1,334 |
1,314 |
$35K |
| A7034 |
Nasal application device |
1,634 |
1,623 |
$30K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
128 |
115 |
$26K |
| E0443 |
Portable 02 contents, gas |
970 |
969 |
$26K |
| E0570 |
Nebulizer with compression |
2,499 |
2,494 |
$23K |
| K0001 |
Standard wheelchair |
925 |
917 |
$19K |
| A7037 |
Pos airway pressure tubing |
3,007 |
2,983 |
$19K |
| A7035 |
Pos airway press headgear |
2,133 |
2,119 |
$19K |
| E0143 |
Walker folding wheeled w/o s |
263 |
263 |
$16K |
| E0562 |
Humidifier heated used w pap |
2,071 |
2,050 |
$15K |
| A7038 |
Pos airway pressure filter |
5,222 |
5,142 |
$13K |
| E0600 |
Suction pump portab hom modl |
218 |
218 |
$4K |
| E0470 |
Rad w/o backup non-inv intfc |
37 |
37 |
$3K |
| A7046 |
Repl water chamber, pap dev |
1,267 |
1,260 |
$3K |
| B4034 |
Enter feed supkit syr by day |
28 |
27 |
$1K |
| E0565 |
Compressor air power source |
51 |
51 |
$1K |
| A7003 |
Nebulizer administration set |
557 |
534 |
$860.17 |
| A7033 |
Replacement nasal pillows |
64 |
62 |
$833.07 |
| E0163 |
Commode chair with fixed arm |
12 |
12 |
$591.40 |
| A7000 |
Disposable canister for pump |
58 |
56 |
$347.36 |
| A4604 |
Tubing with heating element |
12 |
12 |
$133.93 |
| K0195 |
Elevating whlchair leg rests |
61 |
61 |
$121.18 |
| A7002 |
Tubing used w suction pump |
44 |
43 |
$94.46 |
| A4628 |
Oropharyngeal suction cath |
27 |
26 |
$69.40 |
| A7039 |
Filter, non disposable w pap |
27 |
25 |
$42.79 |