| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
475 |
283 |
$73K |
| E0601 |
Cont airway pressure device |
2,711 |
2,556 |
$68K |
| A4604 |
Tubing with heating element |
1,591 |
1,399 |
$66K |
| E1390 |
Oxygen concentrator |
2,002 |
1,811 |
$66K |
| E1028 |
W/c manual swingaway |
401 |
345 |
$58K |
| A7032 |
Replacement nasal cushion |
706 |
660 |
$49K |
| E1399 |
Durable medical equipment mi |
109 |
54 |
$48K |
| A7030 |
Cpap full face mask |
853 |
753 |
$48K |
| A7031 |
Replacement facemask interfa |
1,181 |
1,082 |
$38K |
| A7034 |
Nasal application device |
744 |
648 |
$28K |
| E1161 |
Manual adult wc w tiltinspac |
103 |
96 |
$27K |
| E0562 |
Humidifier heated used w pap |
311 |
276 |
$18K |
| A7035 |
Pos airway press headgear |
1,090 |
971 |
$16K |
| A7038 |
Pos airway pressure filter |
2,965 |
2,756 |
$15K |
| K0739 |
Repair/svc dme non-oxygen eq |
486 |
461 |
$14K |
| E1392 |
Portable oxygen concentrator |
681 |
585 |
$13K |
| E0955 |
Cushioned headrest |
206 |
196 |
$12K |
| E0973 |
W/ch access det adj armrest |
77 |
76 |
$11K |
| A7046 |
Repl water chamber, pap dev |
485 |
424 |
$6K |
| E0978 |
W/c acc,saf belt pelv strap |
104 |
103 |
$3K |
| E0570 |
Nebulizer with compression |
280 |
242 |
$2K |
| E0971 |
Wheelchair anti-tipping devi |
38 |
38 |
$2K |
| E0960 |
W/c shoulder harness/straps |
29 |
28 |
$2K |
| K0040 |
Adjustable angle footplate |
27 |
27 |
$2K |
| A7033 |
Replacement nasal pillows |
31 |
31 |
$2K |
| A7037 |
Pos airway pressure tubing |
12 |
12 |
$294.94 |
| K0738 |
Portable gas oxygen system |
12 |
12 |
$194.15 |
| A7039 |
Filter, non disposable w pap |
12 |
12 |
$151.31 |