| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
4,395 |
4,347 |
$373K |
| K0003 |
Lightweight wheelchair |
1,710 |
1,685 |
$90K |
| E0260 |
Hosp bed semi-electr w/ matt |
921 |
908 |
$67K |
| E0431 |
Portable gaseous 02 |
4,332 |
4,283 |
$64K |
| K0001 |
Standard wheelchair |
624 |
621 |
$22K |
| E0570 |
Nebulizer with compression |
202 |
202 |
$15K |
| K0195 |
Elevating whlchair leg rests |
859 |
845 |
$10K |
| K0007 |
Extra heavy duty wheelchair |
49 |
49 |
$4K |
| E0601 |
Cont airway pressure device |
102 |
102 |
$3K |
| A7005 |
Nondisposable nebulizer set |
189 |
189 |
$2K |
| A4617 |
Mouth piece |
189 |
189 |
$368.05 |
| A7015 |
Aerosol mask used w nebulize |
196 |
196 |
$179.72 |
| A7013 |
Disposable compressor filter |
189 |
189 |
$153.52 |
| E0261 |
Hosp bed semi-electr w/o mat |
117 |
116 |
$0.00 |