| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
5,071 |
5,059 |
$245K |
| E0601 |
Cont airway pressure device |
3,208 |
3,196 |
$108K |
| A7030 |
Cpap full face mask |
1,475 |
1,473 |
$102K |
| B4161 |
Ef ped hydrolyzed/amino acid |
132 |
127 |
$70K |
| E0570 |
Nebulizer with compression |
2,001 |
2,000 |
$37K |
| A7037 |
Pos airway pressure tubing |
2,215 |
2,208 |
$28K |
| E0562 |
Humidifier heated used w pap |
978 |
974 |
$23K |
| A7034 |
Nasal application device |
476 |
472 |
$21K |
| E0431 |
Portable gaseous 02 |
2,496 |
2,488 |
$20K |
| A7035 |
Pos airway press headgear |
1,365 |
1,359 |
$19K |
| T4523 |
Adult size brief/diaper lg |
205 |
203 |
$16K |
| K0738 |
Portable gas oxygen system |
703 |
701 |
$13K |
| K0001 |
Standard wheelchair |
655 |
653 |
$10K |
| E0260 |
Hosp bed semi-electr w/ matt |
296 |
296 |
$9K |
| T4541 |
Large disposable underpad |
267 |
266 |
$8K |
| A7038 |
Pos airway pressure filter |
2,574 |
2,565 |
$7K |
| T4535 |
Disposable liner/shield/pad |
194 |
190 |
$6K |
| A7031 |
Replacement facemask interfa |
177 |
177 |
$4K |
| E0470 |
Rad w/o backup non-inv intfc |
39 |
39 |
$2K |
| A7005 |
Nondisposable nebulizer set |
88 |
88 |
$1K |
| A9901 |
Delivery/set up/dispensing |
330 |
317 |
$954.83 |
| A7046 |
Repl water chamber, pap dev |
97 |
97 |
$680.11 |
| A7013 |
Disposable compressor filter |
88 |
88 |
$85.82 |
| A7003 |
Nebulizer administration set |
27 |
27 |
$47.93 |