| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
2,703 |
2,655 |
$287K |
| E0601 |
Cont airway pressure device |
1,656 |
1,612 |
$158K |
| E0431 |
Portable gaseous 02 |
2,697 |
2,654 |
$61K |
| E0562 |
Humidifier heated used w pap |
2,024 |
1,973 |
$58K |
| E0470 |
Rad w/o backup non-inv intfc |
221 |
218 |
$47K |
| K0001 |
Standard wheelchair |
223 |
213 |
$13K |
| T4541 |
Large disposable underpad |
326 |
326 |
$12K |
| T4535 |
Disposable liner/shield/pad |
111 |
110 |
$4K |
| E0570 |
Nebulizer with compression |
35 |
33 |
$3K |
| A7037 |
Pos airway pressure tubing |
102 |
102 |
$3K |
| A4670 |
Automatic bp monitor, dial |
24 |
24 |
$2K |
| A7035 |
Pos airway press headgear |
101 |
101 |
$2K |
| E0443 |
Portable 02 contents, gas |
40 |
39 |
$2K |
| A7038 |
Pos airway pressure filter |
99 |
99 |
$1K |
| A7034 |
Nasal application device |
26 |
26 |
$1K |
| A7039 |
Filter, non disposable w pap |
99 |
99 |
$1K |
| K0195 |
Elevating whlchair leg rests |
12 |
12 |
$136.22 |
| A6250 |
Skin seal protect moisturizr |
21 |
21 |
$14.69 |
| A4335 |
Incontinence supply |
17 |
17 |
$12.66 |
| T4527 |
Adult size pull-on lg |
14 |
14 |
$0.00 |