| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
493 |
491 |
$11K |
| A7031 |
Face mask interface, replacement for full face mask, each |
88 |
88 |
$4K |
| A7030 |
Full face mask used with positive airway pressure device, each |
91 |
90 |
$3K |
| A7035 |
Headgear used with positive airway pressure device |
75 |
75 |
$895.22 |
| K0001 |
Standard wheelchair |
178 |
177 |
$824.55 |
| A7037 |
Tubing used with positive airway pressure device |
91 |
91 |
$639.25 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
187 |
183 |
$338.30 |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
14 |
14 |
$262.93 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
51 |
51 |
$242.72 |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
52 |
51 |
$207.82 |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
49 |
49 |
$113.36 |