| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6220 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
3,021 |
761 |
$490K |
| A6403 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing |
3,078 |
775 |
$320K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
1,175 |
1,004 |
$46K |
| A7006 |
Administration set, with small volume filtered pneumatic nebulizer |
6,346 |
5,936 |
$35K |
| A4452 |
Tape, waterproof, per 18 square inches |
3,040 |
760 |
$30K |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
2,640 |
2,385 |
$21K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
6,338 |
5,930 |
$16K |
| E0570 |
Nebulizer, with compressor |
452 |
418 |
$14K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
7,879 |
7,286 |
$7K |
| A7015 |
Aerosol mask, used with dme nebulizer |
7,981 |
7,367 |
$6K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
105 |
65 |
$5K |
| A5513 |
For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
31 |
25 |
$3K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
60 |
26 |
$2K |
| A7004 |
Small volume nonfiltered pneumatic nebulizer, disposable |
2,530 |
2,344 |
$215.48 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
25 |
24 |
$208.98 |