| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0601 |
Cont airway pressure device |
303 |
302 |
$65K |
| A7034 |
Nasal application device |
545 |
534 |
$55K |
| E0604 |
Hosp grade elec breast pump |
917 |
901 |
$50K |
| S9999 |
Sales tax |
4,575 |
4,273 |
$47K |
| A4604 |
Tubing with heating element |
696 |
680 |
$40K |
| A7035 |
Pos airway press headgear |
733 |
717 |
$25K |
| A7038 |
Pos airway pressure filter |
2,033 |
2,008 |
$19K |
| A7039 |
Filter, non disposable w pap |
650 |
638 |
$8K |
| A7005 |
Nondisposable nebulizer set |
251 |
250 |
$8K |
| E0562 |
Humidifier heated used w pap |
26 |
25 |
$7K |
| E0143 |
Walker folding wheeled w/o s |
93 |
93 |
$7K |
| E0603 |
Electric breast pump |
29 |
29 |
$3K |
| A7032 |
Replacement nasal cushion |
68 |
66 |
$2K |
| A7033 |
Replacement nasal pillows |
25 |
25 |
$607.62 |
| A7037 |
Pos airway pressure tubing |
12 |
12 |
$428.58 |
| A7046 |
Repl water chamber, pap dev |
18 |
18 |
$304.87 |
| A7015 |
Aerosol mask used w nebulize |
99 |
99 |
$191.36 |