| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6196 |
Alginate dressing <=16 sq in |
1,880 |
1,393 |
$127K |
| E1390 |
Oxygen concentrator |
5,493 |
4,224 |
$98K |
| A6021 |
Collagen dressing <=16 sq in |
840 |
669 |
$93K |
| A6212 |
Foam drg <=16 sq in w/border |
1,761 |
1,342 |
$68K |
| A6197 |
Alginate drsg >16 <=48 sq in |
381 |
274 |
$59K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
1,914 |
1,431 |
$47K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
1,079 |
820 |
$35K |
| A6266 |
Impreg gauze no h20/sal/yard |
455 |
358 |
$20K |
| A4452 |
Waterproof tape |
2,291 |
1,756 |
$19K |
| E0431 |
Portable gaseous 02 |
3,002 |
2,423 |
$15K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
863 |
643 |
$15K |
| A7030 |
Cpap full face mask |
350 |
269 |
$14K |
| A6402 |
Sterile gauze <= 16 sq in |
2,867 |
2,245 |
$12K |
| A6251 |
Absorpt drg <=16 sq in w/o b |
504 |
375 |
$8K |
| E0601 |
Cont airway pressure device |
621 |
498 |
$6K |
| A7037 |
Pos airway pressure tubing |
764 |
595 |
$5K |
| A6216 |
Non-sterile gauze<=16 sq in |
897 |
687 |
$5K |
| A4450 |
Non-waterproof tape |
1,500 |
1,139 |
$4K |
| A6446 |
Conform band s w>=3" <5"/yd |
1,411 |
1,014 |
$4K |
| E0570 |
Nebulizer with compression |
570 |
496 |
$3K |
| A7038 |
Pos airway pressure filter |
944 |
709 |
$2K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
60 |
54 |
$2K |
| E0562 |
Humidifier heated used w pap |
212 |
175 |
$2K |
| A6443 |
Conform band n/s w>=3"<5"/yd |
140 |
110 |
$2K |
| A7035 |
Pos airway press headgear |
177 |
141 |
$1K |
| A6219 |
Gauze <= 16 sq in w/border |
138 |
111 |
$902.38 |
| A7031 |
Replacement facemask interfa |
32 |
26 |
$572.74 |
| A7039 |
Filter, non disposable w pap |
50 |
37 |
$109.20 |
| A5120 |
Skin barrier, wipe or swab |
39 |
31 |
$55.00 |
| A6261 |
Wound filler gel/paste /oz |
17 |
13 |
$23.24 |
| A7046 |
Repl water chamber, pap dev |
18 |
12 |
$22.10 |
| A9279 |
Monitoring feature/devicenoc |
30 |
24 |
$0.00 |