| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
4,060 |
4,041 |
$228K |
| E0601 |
Cont airway pressure device |
1,075 |
1,067 |
$45K |
| E0431 |
Portable gaseous 02 |
2,641 |
2,629 |
$30K |
| A7030 |
Cpap full face mask |
149 |
148 |
$9K |
| E0562 |
Humidifier heated used w pap |
605 |
605 |
$8K |
| A7038 |
Pos airway pressure filter |
491 |
487 |
$5K |
| A7037 |
Pos airway pressure tubing |
312 |
309 |
$5K |
| A7035 |
Pos airway press headgear |
182 |
181 |
$3K |
| A7031 |
Replacement facemask interfa |
53 |
52 |
$1K |
| E0570 |
Nebulizer with compression |
136 |
135 |
$1K |
| A7046 |
Repl water chamber, pap dev |
71 |
71 |
$440.96 |
| A7039 |
Filter, non disposable w pap |
41 |
41 |
$174.48 |
| A6402 |
Sterile gauze <= 16 sq in |
13 |
12 |
$85.38 |
| A4450 |
Non-waterproof tape |
14 |
13 |
$62.69 |