| 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 |
2,286 |
1,954 |
$99K |
| E0570 |
Nebulizer, with compressor |
1,664 |
1,341 |
$42K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
253 |
177 |
$28K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,492 |
2,109 |
$25K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
314 |
153 |
$22K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
134 |
100 |
$19K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
862 |
560 |
$19K |
| 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 |
310 |
156 |
$17K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,149 |
730 |
$13K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
345 |
280 |
$11K |
| A4452 |
Tape, waterproof, per 18 square inches |
565 |
339 |
$9K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
260 |
241 |
$8K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
43 |
42 |
$4K |
| A7030 |
Full face mask used with positive airway pressure device, each |
34 |
33 |
$2K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
154 |
142 |
$2K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
40 |
38 |
$1K |
| A6549 |
Gradient compression garment, not otherwise specified, for daytime use, each |
27 |
13 |
$929.99 |
| L0621 |
Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf |
12 |
12 |
$902.14 |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
13 |
13 |
$682.07 |
| A4649 |
Surgical supply; miscellaneous |
52 |
27 |
$560.23 |
| A7035 |
Headgear used with positive airway pressure device |
30 |
30 |
$393.92 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
78 |
75 |
$329.77 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
26 |
26 |
$124.66 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
68 |
54 |
$17.74 |