| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
643 |
639 |
$44K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
563 |
559 |
$7K |
| K0001 |
Standard wheelchair |
192 |
192 |
$3K |
| A4554 |
Disposable underpads, all sizes |
70 |
70 |
$3K |
| A4335 |
Incontinence supply; miscellaneous |
174 |
174 |
$899.10 |
| E0570 |
Nebulizer, with compressor |
13 |
13 |
$395.06 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
12 |
12 |
$32.13 |
| A7015 |
Aerosol mask, used with dme nebulizer |
12 |
12 |
$12.66 |