| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
5,839 |
4,050 |
$332K |
| E0445 |
Oximeter non-invasive |
796 |
659 |
$115K |
| B4035 |
Enteral feed supp pump per d |
485 |
241 |
$50K |
| K0738 |
Portable gas oxygen system |
2,196 |
1,877 |
$46K |
| B4152 |
Ef calorie dense>/=1.5kcal |
274 |
154 |
$27K |
| A4629 |
Tracheostomy care kit |
265 |
223 |
$26K |
| A4554 |
Disposable underpads |
436 |
395 |
$22K |
| E0260 |
Hosp bed semi-electr w/ matt |
816 |
643 |
$22K |
| A4623 |
Tracheostomy inner cannula |
179 |
136 |
$20K |
| E0465 |
Home vent invasive interface |
13 |
12 |
$14K |
| E1392 |
Portable oxygen concentrator |
700 |
589 |
$11K |
| B4034 |
Enter feed supkit syr by day |
216 |
122 |
$11K |
| A7526 |
Tracheostomy tube collar |
420 |
338 |
$10K |
| E0601 |
Cont airway pressure device |
282 |
225 |
$10K |
| E0431 |
Portable gaseous 02 |
535 |
509 |
$9K |
| A7000 |
Disposable canister for pump |
502 |
424 |
$7K |
| A7030 |
Cpap full face mask |
93 |
74 |
$6K |
| E0630 |
Patient lift hydraulic |
141 |
127 |
$6K |
| K0003 |
Lightweight wheelchair |
134 |
111 |
$5K |
| A4624 |
Tracheal suction tube |
35 |
25 |
$5K |
| E0600 |
Suction pump portab hom modl |
105 |
100 |
$3K |
| K0001 |
Standard wheelchair |
313 |
286 |
$2K |
| A7035 |
Pos airway press headgear |
143 |
125 |
$2K |
| A7002 |
Tubing used w suction pump |
459 |
388 |
$2K |
| T4527 |
Adult size pull-on lg |
15 |
14 |
$2K |
| E0570 |
Nebulizer with compression |
247 |
245 |
$2K |
| K0195 |
Elevating whlchair leg rests |
210 |
206 |
$1K |
| A4628 |
Oropharyngeal suction cath |
207 |
169 |
$1K |
| A7038 |
Pos airway pressure filter |
365 |
272 |
$712.96 |
| A7034 |
Nasal application device |
13 |
12 |
$513.94 |
| A7003 |
Nebulizer administration set |
276 |
242 |
$500.34 |
| K0004 |
High strength ltwt whlchr |
28 |
25 |
$184.42 |
| A7031 |
Replacement facemask interfa |
19 |
12 |
$172.36 |
| A4604 |
Tubing with heating element |
30 |
25 |
$159.82 |
| A7525 |
Tracheostomy mask |
276 |
196 |
$159.08 |