| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
3,520 |
3,061 |
$198K |
| E0601 |
Cont airway pressure device |
1,731 |
1,600 |
$96K |
| A5500 |
Diab shoe for density insert |
1,805 |
1,000 |
$45K |
| E0570 |
Nebulizer with compression |
2,013 |
1,752 |
$41K |
| K0001 |
Standard wheelchair |
3,235 |
2,683 |
$32K |
| A7030 |
Cpap full face mask |
349 |
315 |
$29K |
| E0261 |
Hosp bed semi-electr w/o mat |
700 |
589 |
$19K |
| A5512 |
Multi den insert direct form |
1,797 |
995 |
$18K |
| E0260 |
Hosp bed semi-electr w/ matt |
346 |
324 |
$12K |
| L1832 |
Ko adj jnt pos r sup pre cst |
40 |
38 |
$12K |
| E0431 |
Portable gaseous 02 |
1,743 |
1,509 |
$9K |
| A7037 |
Pos airway pressure tubing |
316 |
287 |
$7K |
| E0143 |
Walker folding wheeled w/o s |
52 |
49 |
$2K |
| A7038 |
Pos airway pressure filter |
315 |
251 |
$2K |
| E0971 |
Wheelchair anti-tipping devi |
1,169 |
376 |
$985.09 |
| L3908 |
Who cock-up nonmolde pre ots |
45 |
29 |
$966.91 |
| A6196 |
Alginate dressing <=16 sq in |
17 |
17 |
$615.35 |
| A7003 |
Nebulizer administration set |
192 |
175 |
$274.86 |
| A7035 |
Pos airway press headgear |
14 |
14 |
$244.56 |
| A7005 |
Nondisposable nebulizer set |
12 |
12 |
$199.72 |
| A6446 |
Conform band s w>=3" <5"/yd |
13 |
13 |
$116.95 |
| A4452 |
Waterproof tape |
15 |
14 |
$70.28 |