| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
1,023 |
1,018 |
$226K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
764 |
763 |
$32K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
45 |
41 |
$3K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
50 |
50 |
$2K |
| A4217 |
Sterile water/saline, 500 ml |
73 |
73 |
$1K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
36 |
36 |
$321.90 |