| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
5,197 |
4,736 |
$213K |
| E0431 |
Portable gaseous 02 |
3,259 |
3,001 |
$31K |
| A6196 |
Alginate dressing <=16 sq in |
293 |
236 |
$29K |
| A6212 |
Foam drg <=16 sq in w/border |
120 |
105 |
$10K |
| E0601 |
Cont airway pressure device |
349 |
335 |
$8K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
73 |
64 |
$3K |
| A6402 |
Sterile gauze <= 16 sq in |
314 |
254 |
$1K |
| A6446 |
Conform band s w>=3" <5"/yd |
95 |
80 |
$1K |
| A4452 |
Waterproof tape |
40 |
37 |
$788.96 |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
19 |
13 |
$533.71 |
| A6219 |
Gauze <= 16 sq in w/border |
32 |
25 |
$71.28 |
| A4450 |
Non-waterproof tape |
17 |
13 |
$53.28 |
| A7038 |
Pos airway pressure filter |
22 |
13 |
$23.00 |