| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
1,669 |
1,669 |
$102K |
| E0570 |
Nebulizer with compression |
1,888 |
1,888 |
$97K |
| A5512 |
Multi den insert direct form |
2,526 |
1,527 |
$50K |
| A5500 |
Diab shoe for density insert |
2,654 |
1,595 |
$46K |
| E0601 |
Cont airway pressure device |
484 |
484 |
$22K |
| E0431 |
Portable gaseous 02 |
1,184 |
1,184 |
$14K |
| E0562 |
Humidifier heated used w pap |
544 |
542 |
$7K |
| K0001 |
Standard wheelchair |
125 |
125 |
$2K |
| E0260 |
Hosp bed semi-electr w/ matt |
13 |
13 |
$539.43 |
| A7015 |
Aerosol mask used w nebulize |
322 |
322 |
$516.48 |
| A7038 |
Pos airway pressure filter |
104 |
104 |
$486.47 |
| A7003 |
Nebulizer administration set |
94 |
94 |
$305.23 |
| A7030 |
Cpap full face mask |
12 |
12 |
$179.19 |