| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
1,524 |
1,056 |
$66K |
| T4527 |
Adult size pull-on lg |
805 |
533 |
$62K |
| A4554 |
Disposable underpads |
1,909 |
1,362 |
$61K |
| E0260 |
Hosp bed semi-electr w/ matt |
2,391 |
1,451 |
$41K |
| E0601 |
Cont airway pressure device |
1,190 |
780 |
$36K |
| K0001 |
Standard wheelchair |
2,625 |
1,659 |
$20K |
| A7030 |
Cpap full face mask |
208 |
145 |
$11K |
| E0431 |
Portable gaseous 02 |
790 |
559 |
$7K |
| E0570 |
Nebulizer with compression |
456 |
309 |
$4K |
| E0562 |
Humidifier heated used w pap |
110 |
84 |
$4K |
| T4528 |
Adult size pull-on xl |
45 |
25 |
$3K |
| A7035 |
Pos airway press headgear |
206 |
141 |
$2K |
| A7038 |
Pos airway pressure filter |
624 |
471 |
$2K |
| A7031 |
Replacement facemask interfa |
33 |
25 |
$1K |
| A4604 |
Tubing with heating element |
177 |
119 |
$1K |
| K0195 |
Elevating whlchair leg rests |
44 |
25 |
$81.96 |