| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
3,779 |
3,282 |
$129K |
| E0601 |
Cont airway pressure device |
1,214 |
1,129 |
$40K |
| E0431 |
Portable gaseous 02 |
2,036 |
1,788 |
$15K |
| A7030 |
Cpap full face mask |
221 |
203 |
$12K |
| E0562 |
Humidifier heated used w pap |
995 |
929 |
$9K |
| A7031 |
Replacement facemask interfa |
324 |
302 |
$9K |
| A4604 |
Tubing with heating element |
171 |
164 |
$5K |
| A7035 |
Pos airway press headgear |
208 |
191 |
$3K |
| A7038 |
Pos airway pressure filter |
688 |
603 |
$2K |
| A7037 |
Pos airway pressure tubing |
170 |
158 |
$1K |
| A7046 |
Repl water chamber, pap dev |
110 |
107 |
$1K |
| A6402 |
Sterile gauze <= 16 sq in |
54 |
41 |
$441.22 |
| A4450 |
Non-waterproof tape |
16 |
13 |
$96.52 |