| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
5,505 |
4,742 |
$212K |
| E0601 |
Cont airway pressure device |
1,654 |
1,465 |
$53K |
| A6266 |
Impreg gauze no h20/sal/yard |
226 |
180 |
$33K |
| E0431 |
Portable gaseous 02 |
2,926 |
2,438 |
$23K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
82 |
69 |
$7K |
| E0562 |
Humidifier heated used w pap |
461 |
419 |
$6K |
| A7037 |
Pos airway pressure tubing |
563 |
501 |
$4K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
87 |
73 |
$4K |
| A6402 |
Sterile gauze <= 16 sq in |
344 |
281 |
$3K |
| A7038 |
Pos airway pressure filter |
922 |
772 |
$2K |
| E0570 |
Nebulizer with compression |
265 |
206 |
$2K |
| A7030 |
Cpap full face mask |
34 |
28 |
$949.98 |
| A7046 |
Repl water chamber, pap dev |
97 |
91 |
$836.14 |
| E1392 |
Portable oxygen concentrator |
39 |
37 |
$802.36 |
| A7035 |
Pos airway press headgear |
62 |
54 |
$625.75 |
| A7034 |
Nasal application device |
16 |
12 |
$505.29 |
| A7031 |
Replacement facemask interfa |
12 |
12 |
$204.12 |
| A4604 |
Tubing with heating element |
16 |
13 |
$198.39 |
| A7039 |
Filter, non disposable w pap |
43 |
40 |
$186.42 |
| A4450 |
Non-waterproof tape |
30 |
24 |
$150.06 |
| K0001 |
Standard wheelchair |
16 |
12 |
$135.99 |