| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
694 |
677 |
$16K |
| E0601 |
Continuous positive airway pressure (cpap) device |
421 |
418 |
$11K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
150 |
150 |
$2K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
226 |
222 |
$730.07 |
| A7031 |
Face mask interface, replacement for full face mask, each |
36 |
36 |
$692.55 |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
86 |
85 |
$365.70 |
| A7030 |
Full face mask used with positive airway pressure device, each |
13 |
13 |
$294.99 |
| A7035 |
Headgear used with positive airway pressure device |
29 |
29 |
$178.03 |