| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H2010 |
Comprehensive med svc 15 min |
8,744 |
162 |
$42K |
| E1390 |
Oxygen concentrator |
918 |
913 |
$37K |
| E0601 |
Cont airway pressure device |
746 |
746 |
$24K |
| A9901 |
Delivery/set up/dispensing |
1,057 |
1,029 |
$18K |
| E0570 |
Nebulizer with compression |
54 |
54 |
$6K |
| K0738 |
Portable gas oxygen system |
317 |
314 |
$4K |
| A7038 |
Pos airway pressure filter |
1,204 |
1,196 |
$4K |
| A7035 |
Pos airway press headgear |
129 |
129 |
$2K |
| A4604 |
Tubing with heating element |
42 |
42 |
$1K |
| A5500 |
Diab shoe for density insert |
34 |
29 |
$1K |
| A7005 |
Nondisposable nebulizer set |
57 |
56 |
$1K |
| A7030 |
Cpap full face mask |
12 |
12 |
$939.86 |
| S9430 |
Pharmacy comp/disp serv |
166 |
166 |
$704.00 |
| A7031 |
Replacement facemask interfa |
24 |
24 |
$651.64 |
| E0562 |
Humidifier heated used w pap |
12 |
12 |
$389.47 |
| A7039 |
Filter, non disposable w pap |
13 |
13 |
$50.12 |
| 90688 |
|
34 |
34 |
$0.00 |
| 90674 |
|
19 |
19 |
$0.00 |
| G0008 |
Admin influenza virus vac |
131 |
131 |
$0.00 |
| 90686 |
|
21 |
21 |
$0.00 |