| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
6,233 |
5,185 |
$316K |
| E0431 |
Portable gaseous 02 |
4,951 |
4,100 |
$55K |
| A6196 |
Alginate dressing <=16 sq in |
177 |
124 |
$18K |
| A6402 |
Sterile gauze <= 16 sq in |
467 |
350 |
$17K |
| K0001 |
Standard wheelchair |
901 |
698 |
$16K |
| E0601 |
Cont airway pressure device |
259 |
222 |
$9K |
| A6212 |
Foam drg <=16 sq in w/border |
120 |
84 |
$9K |
| A4452 |
Waterproof tape |
461 |
346 |
$7K |
| E0261 |
Hosp bed semi-electr w/o mat |
187 |
99 |
$5K |
| A6446 |
Conform band s w>=3" <5"/yd |
327 |
245 |
$4K |
| A6251 |
Absorpt drg <=16 sq in w/o b |
121 |
90 |
$4K |
| K0003 |
Lightweight wheelchair |
74 |
51 |
$2K |
| A7038 |
Pos airway pressure filter |
241 |
219 |
$2K |
| A7030 |
Cpap full face mask |
16 |
12 |
$1K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
43 |
27 |
$1K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
18 |
14 |
$1K |
| A7037 |
Pos airway pressure tubing |
68 |
63 |
$1K |
| E0562 |
Humidifier heated used w pap |
93 |
76 |
$677.97 |
| A6457 |
Tubular dressing |
69 |
45 |
$233.39 |
| A4450 |
Non-waterproof tape |
17 |
12 |
$16.17 |