| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0603 |
Electric breast pump |
184 |
184 |
$17K |
| A7030 |
Cpap full face mask |
91 |
91 |
$8K |
| A4604 |
Tubing with heating element |
156 |
156 |
$4K |
| A7031 |
Replacement facemask interfa |
136 |
136 |
$3K |
| E0601 |
Cont airway pressure device |
65 |
65 |
$2K |
| A7034 |
Nasal application device |
59 |
59 |
$2K |
| A7032 |
Replacement nasal cushion |
39 |
39 |
$2K |
| E1390 |
Oxygen concentrator |
30 |
30 |
$2K |
| A7038 |
Pos airway pressure filter |
503 |
478 |
$2K |
| A7035 |
Pos airway press headgear |
65 |
65 |
$816.24 |
| A7033 |
Replacement nasal pillows |
19 |
18 |
$433.08 |
| A7046 |
Repl water chamber, pap dev |
62 |
62 |
$413.40 |
| E0570 |
Nebulizer with compression |
12 |
12 |
$204.78 |
| E0431 |
Portable gaseous 02 |
12 |
12 |
$141.63 |
| A7039 |
Filter, non disposable w pap |
14 |
14 |
$47.40 |