| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
9,731 |
8,101 |
$321K |
| E0466 |
Home vent non-invasive inter |
404 |
299 |
$94K |
| A5512 |
Multi den insert direct form |
1,008 |
524 |
$39K |
| A5500 |
Diab shoe for density insert |
1,040 |
537 |
$34K |
| E0431 |
Portable gaseous 02 |
4,625 |
3,817 |
$34K |
| E0601 |
Cont airway pressure device |
1,450 |
1,121 |
$33K |
| E0562 |
Humidifier heated used w pap |
2,164 |
1,537 |
$15K |
| E0570 |
Nebulizer with compression |
978 |
731 |
$11K |
| A7030 |
Cpap full face mask |
240 |
182 |
$10K |
| A7037 |
Pos airway pressure tubing |
344 |
271 |
$2K |
| A7031 |
Replacement facemask interfa |
71 |
55 |
$1K |
| A7035 |
Pos airway press headgear |
125 |
98 |
$993.59 |
| A7038 |
Pos airway pressure filter |
387 |
298 |
$750.99 |
| A4595 |
Tens suppl 2 lead per month |
12 |
12 |
$558.12 |
| A7039 |
Filter, non disposable w pap |
62 |
55 |
$229.21 |
| K0001 |
Standard wheelchair |
53 |
38 |
$146.89 |
| A7003 |
Nebulizer administration set |
15 |
13 |
$17.66 |