| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
15,993 |
15,842 |
$1.16M |
| E0466 |
Home vent non-invasive inter |
2,563 |
2,487 |
$809K |
| T4541 |
Large disposable underpad |
13,945 |
13,899 |
$718K |
| E0471 |
Rad w/backup non inv intrfc |
2,372 |
2,337 |
$703K |
| T4527 |
Adult size pull-on lg |
7,520 |
7,091 |
$482K |
| T4535 |
Disposable liner/shield/pad |
8,362 |
7,986 |
$414K |
| T4528 |
Adult size pull-on xl |
4,802 |
4,749 |
$358K |
| T4526 |
Adult size pull-on med |
6,051 |
5,772 |
$339K |
| E0601 |
Cont airway pressure device |
5,574 |
5,492 |
$318K |
| E0470 |
Rad w/o backup non-inv intfc |
2,088 |
2,065 |
$292K |
| T4523 |
Adult size brief/diaper lg |
1,455 |
1,448 |
$163K |
| E0562 |
Humidifier heated used w pap |
8,800 |
8,744 |
$136K |
| A7030 |
Cpap full face mask |
2,882 |
2,881 |
$120K |
| T4524 |
Adult size brief/diaper xl |
955 |
951 |
$92K |
| A4604 |
Tubing with heating element |
4,030 |
4,023 |
$86K |
| A7031 |
Replacement facemask interfa |
2,574 |
2,557 |
$80K |
| K0738 |
Portable gas oxygen system |
3,018 |
2,999 |
$71K |
| E0431 |
Portable gaseous 02 |
4,666 |
4,604 |
$64K |
| T4525 |
Adult size pull-on sm |
1,255 |
1,118 |
$62K |
| E1392 |
Portable oxygen concentrator |
2,748 |
2,732 |
$56K |
| A7034 |
Nasal application device |
1,509 |
1,509 |
$56K |
| T4522 |
Adult size brief/diaper med |
684 |
679 |
$54K |
| E0570 |
Nebulizer with compression |
5,597 |
5,523 |
$48K |
| K0001 |
Standard wheelchair |
1,951 |
1,927 |
$45K |
| A7032 |
Replacement nasal cushion |
964 |
958 |
$29K |
| A7038 |
Pos airway pressure filter |
6,226 |
6,220 |
$28K |
| A7035 |
Pos airway press headgear |
2,613 |
2,611 |
$23K |
| A7046 |
Repl water chamber, pap dev |
2,090 |
2,086 |
$18K |
| A7039 |
Filter, non disposable w pap |
3,024 |
3,023 |
$9K |
| S9999 |
Sales tax |
3,226 |
3,153 |
$9K |
| A7033 |
Replacement nasal pillows |
228 |
228 |
$7K |
| E0143 |
Walker folding wheeled w/o s |
207 |
197 |
$6K |
| A7005 |
Nondisposable nebulizer set |
1,002 |
987 |
$6K |
| A7037 |
Pos airway pressure tubing |
388 |
388 |
$2K |
| E0600 |
Suction pump portab hom modl |
24 |
24 |
$576.67 |
| A7015 |
Aerosol mask used w nebulize |
151 |
147 |
$239.47 |
| A7036 |
Pos airway press chinstrap |
14 |
14 |
$97.70 |