| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
2,928 |
2,222 |
$162K |
| A7030 |
Cpap full face mask |
1,300 |
1,053 |
$106K |
| E0601 |
Cont airway pressure device |
2,445 |
1,913 |
$68K |
| A4604 |
Tubing with heating element |
2,315 |
1,829 |
$62K |
| A7031 |
Replacement facemask interfa |
1,243 |
974 |
$56K |
| E0570 |
Nebulizer with compression |
1,644 |
1,190 |
$18K |
| A7035 |
Pos airway press headgear |
1,231 |
976 |
$17K |
| A7038 |
Pos airway pressure filter |
3,115 |
2,446 |
$15K |
| A7034 |
Nasal application device |
258 |
203 |
$9K |
| E0260 |
Hosp bed semi-electr w/ matt |
548 |
396 |
$9K |
| E0562 |
Humidifier heated used w pap |
136 |
105 |
$6K |
| A7046 |
Repl water chamber, pap dev |
606 |
502 |
$5K |
| K0738 |
Portable gas oxygen system |
212 |
157 |
$3K |
| A7032 |
Replacement nasal cushion |
119 |
100 |
$3K |
| E1392 |
Portable oxygen concentrator |
78 |
64 |
$2K |
| A7003 |
Nebulizer administration set |
579 |
446 |
$1K |
| A4927 |
Non-sterile gloves |
95 |
60 |
$924.18 |
| K0001 |
Standard wheelchair |
37 |
24 |
$160.30 |
| A7039 |
Filter, non disposable w pap |
14 |
14 |
$96.24 |