| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
6,784 |
5,716 |
$345K |
| E0601 |
Cont airway pressure device |
3,119 |
2,753 |
$168K |
| E0570 |
Nebulizer with compression |
4,865 |
4,113 |
$55K |
| A7030 |
Cpap full face mask |
581 |
500 |
$49K |
| K0001 |
Standard wheelchair |
3,680 |
3,191 |
$38K |
| E0250 |
Hosp bed fixed ht w/ mattres |
2,023 |
1,731 |
$31K |
| E0431 |
Portable gaseous 02 |
5,868 |
4,881 |
$29K |
| A7035 |
Pos airway press headgear |
730 |
614 |
$13K |
| A7037 |
Pos airway pressure tubing |
566 |
490 |
$12K |
| A7031 |
Replacement facemask interfa |
245 |
214 |
$9K |
| A7038 |
Pos airway pressure filter |
1,318 |
1,103 |
$6K |
| E0443 |
Portable 02 contents, gas |
154 |
142 |
$3K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
27 |
12 |
$2K |
| E0562 |
Humidifier heated used w pap |
26 |
25 |
$2K |
| E0261 |
Hosp bed semi-electr w/o mat |
45 |
40 |
$2K |
| A7034 |
Nasal application device |
27 |
27 |
$2K |
| A7046 |
Repl water chamber, pap dev |
132 |
122 |
$1K |
| A4253 |
Blood glucose/reagent strips |
254 |
239 |
$973.83 |
| E0143 |
Walker folding wheeled w/o s |
28 |
25 |
$898.84 |
| Q0513 |
Disp fee inhal drugs/30 days |
102 |
101 |
$587.40 |
| A4259 |
Lancets per box |
141 |
138 |
$45.31 |
| A7003 |
Nebulizer administration set |
13 |
12 |
$17.60 |
| A7015 |
Aerosol mask used w nebulize |
13 |
12 |
$12.00 |
| 90662 |
|
34 |
34 |
$0.00 |
| 0011A |
|
112 |
112 |
$0.00 |
| G0008 |
Admin influenza virus vac |
86 |
86 |
$0.00 |
| 0012A |
|
111 |
111 |
$0.00 |
| 90688 |
|
12 |
12 |
$0.00 |
| 0001A |
|
12 |
12 |
$0.00 |
| 90694 |
|
27 |
27 |
$0.00 |