| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
2,619 |
2,299 |
$74K |
| E0570 |
Nebulizer with compression |
1,020 |
830 |
$43K |
| E0600 |
Suction pump portab hom modl |
752 |
664 |
$25K |
| E0431 |
Portable gaseous 02 |
651 |
586 |
$3K |
| A4253 |
Blood glucose/reagent strips |
379 |
276 |
$3K |
| E0260 |
Hosp bed semi-electr w/ matt |
245 |
182 |
$2K |
| Q0513 |
Disp fee inhal drugs/30 days |
207 |
134 |
$1K |
| 0011A |
|
42 |
42 |
$586.38 |
| E0601 |
Cont airway pressure device |
189 |
146 |
$416.20 |
| 0134A |
|
28 |
28 |
$360.00 |
| E1392 |
Portable oxygen concentrator |
99 |
79 |
$305.32 |
| 0064A |
|
33 |
33 |
$282.59 |
| 91322 |
|
13 |
13 |
$259.15 |
| A7004 |
Disposable nebulizer sml vol |
106 |
104 |
$226.29 |
| 0012A |
|
17 |
17 |
$120.00 |
| 0031A |
|
13 |
13 |
$120.00 |
| 90686 |
|
30 |
30 |
$64.56 |
| 90480 |
|
13 |
13 |
$28.30 |
| A4604 |
Tubing with heating element |
43 |
38 |
$1.86 |
| A4259 |
Lancets per box |
16 |
13 |
$0.92 |
| A7003 |
Nebulizer administration set |
15 |
15 |
$0.00 |
| 90662 |
|
72 |
72 |
$0.00 |
| A7038 |
Pos airway pressure filter |
35 |
26 |
$0.00 |
| G0008 |
Admin influenza virus vac |
135 |
135 |
$0.00 |
| 90688 |
|
28 |
28 |
$0.00 |
| G0009 |
Admin pneumococcal vaccine |
13 |
13 |
$0.00 |
| 91301 |
|
16 |
15 |
$0.00 |