| 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 |
6,233 |
5,185 |
$316K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
4,951 |
4,100 |
$55K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
177 |
124 |
$18K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
467 |
350 |
$17K |
| K0001 |
Standard wheelchair |
901 |
698 |
$16K |
| E0601 |
Continuous positive airway pressure (cpap) device |
259 |
222 |
$9K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
120 |
84 |
$9K |
| A4452 |
Tape, waterproof, per 18 square inches |
461 |
346 |
$7K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
187 |
99 |
$5K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
327 |
245 |
$4K |
| A6251 |
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
121 |
90 |
$4K |
| K0003 |
Lightweight wheelchair |
74 |
51 |
$2K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
241 |
219 |
$2K |
| A7030 |
Full face mask used with positive airway pressure device, each |
16 |
12 |
$1K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
43 |
27 |
$1K |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
18 |
14 |
$1K |
| A7037 |
Tubing used with positive airway pressure device |
68 |
63 |
$1K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
93 |
76 |
$677.97 |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
69 |
45 |
$233.39 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
17 |
12 |
$16.17 |