| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
2,361 |
2,237 |
$202K |
| E0601 |
Cont airway pressure device |
729 |
709 |
$30K |
| K0738 |
Portable gas oxygen system |
879 |
814 |
$25K |
| E0562 |
Humidifier heated used w pap |
747 |
720 |
$12K |
| E0260 |
Hosp bed semi-electr w/ matt |
239 |
239 |
$8K |
| K0001 |
Standard wheelchair |
366 |
363 |
$8K |
| E0570 |
Nebulizer with compression |
85 |
85 |
$3K |
| E1392 |
Portable oxygen concentrator |
52 |
50 |
$920.11 |
| A7030 |
Cpap full face mask |
12 |
12 |
$889.56 |
| A7031 |
Replacement facemask interfa |
25 |
25 |
$737.36 |
| A7038 |
Pos airway pressure filter |
101 |
100 |
$430.07 |
| A7037 |
Pos airway pressure tubing |
25 |
25 |
$291.43 |
| A7035 |
Pos airway press headgear |
12 |
12 |
$155.94 |
| A7046 |
Repl water chamber, pap dev |
13 |
13 |
$98.09 |
| A7003 |
Nebulizer administration set |
14 |
14 |
$27.59 |