| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
3,661 |
3,614 |
$265K |
| K0108 |
W/c component-accessory nos |
2,222 |
667 |
$259K |
| E0466 |
Home vent non-invasive inter |
545 |
524 |
$203K |
| E1399 |
Durable medical equipment mi |
412 |
151 |
$191K |
| A7030 |
Cpap full face mask |
1,101 |
1,096 |
$72K |
| A7031 |
Replacement facemask interfa |
1,950 |
1,901 |
$65K |
| E0601 |
Cont airway pressure device |
1,628 |
1,620 |
$56K |
| E1028 |
W/c manual swingaway |
885 |
597 |
$50K |
| E0431 |
Portable gaseous 02 |
2,463 |
2,415 |
$34K |
| K0739 |
Repair/svc dme non-oxygen eq |
617 |
554 |
$31K |
| E0955 |
Cushioned headrest |
452 |
427 |
$31K |
| A7034 |
Nasal application device |
563 |
557 |
$24K |
| E0470 |
Rad w/o backup non-inv intfc |
142 |
142 |
$24K |
| E2617 |
Custom fab w/c back cushion |
14 |
14 |
$23K |
| K0738 |
Portable gas oxygen system |
524 |
513 |
$19K |
| A7032 |
Replacement nasal cushion |
485 |
468 |
$19K |
| A7037 |
Pos airway pressure tubing |
1,010 |
1,002 |
$16K |
| A7038 |
Pos airway pressure filter |
3,315 |
3,182 |
$14K |
| A7035 |
Pos airway press headgear |
939 |
934 |
$12K |
| E0973 |
W/ch access det adj armrest |
173 |
143 |
$12K |
| K0040 |
Adjustable angle footplate |
178 |
152 |
$11K |
| E0960 |
W/c shoulder harness/straps |
172 |
158 |
$10K |
| E0971 |
Wheelchair anti-tipping devi |
292 |
214 |
$8K |
| E0978 |
W/c acc,saf belt pelv strap |
304 |
287 |
$7K |
| E0956 |
W/c lateral trunk/hip suppor |
46 |
27 |
$4K |
| K0001 |
Standard wheelchair |
400 |
392 |
$4K |
| A7046 |
Repl water chamber, pap dev |
642 |
640 |
$4K |
| E2607 |
Skin pro/pos wc cus wd <22in |
12 |
12 |
$3K |
| E0562 |
Humidifier heated used w pap |
24 |
24 |
$3K |
| E0570 |
Nebulizer with compression |
221 |
220 |
$1K |
| E0260 |
Hosp bed semi-electr w/ matt |
67 |
67 |
$833.11 |
| A4604 |
Tubing with heating element |
552 |
551 |
$587.66 |
| A7039 |
Filter, non disposable w pap |
100 |
99 |
$587.29 |
| K0038 |
Leg strap each |
27 |
24 |
$585.75 |
| A7033 |
Replacement nasal pillows |
12 |
12 |
$364.03 |
| E1392 |
Portable oxygen concentrator |
15 |
15 |
$0.00 |