| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
10,735 |
8,718 |
$701K |
| E0431 |
Portable gaseous 02 |
5,936 |
5,077 |
$62K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,476 |
1,247 |
$37K |
| K0001 |
Standard wheelchair |
1,328 |
1,161 |
$16K |
| E0570 |
Nebulizer with compression |
1,100 |
1,005 |
$10K |
| A4385 |
Ost skn barrier sld ext wear |
141 |
111 |
$4K |
| A5063 |
Drain ostomy pouch w/flange |
153 |
134 |
$3K |
| A4406 |
Pectin based ostomy paste |
261 |
205 |
$3K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
30 |
25 |
$1K |
| A7030 |
Cpap full face mask |
15 |
14 |
$871.24 |
| E0443 |
Portable 02 contents, gas |
30 |
25 |
$633.60 |
| A7003 |
Nebulizer administration set |
110 |
97 |
$257.73 |
| A7035 |
Pos airway press headgear |
16 |
15 |
$195.39 |
| A7037 |
Pos airway pressure tubing |
16 |
13 |
$138.70 |
| A4371 |
Skin barrier powder per oz |
49 |
36 |
$109.39 |
| E1392 |
Portable oxygen concentrator |
31 |
27 |
$98.93 |
| A7038 |
Pos airway pressure filter |
13 |
12 |
$44.36 |
| A7015 |
Aerosol mask used w nebulize |
29 |
28 |
$32.21 |