| 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 |
4,035 |
3,070 |
$121K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,836 |
1,545 |
$38K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
187 |
160 |
$28K |
| 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 |
376 |
315 |
$28K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
23 |
17 |
$21K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,882 |
1,451 |
$12K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
939 |
791 |
$12K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
184 |
124 |
$10K |
| A7030 |
Full face mask used with positive airway pressure device, each |
162 |
152 |
$9K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
120 |
98 |
$7K |
| A7035 |
Headgear used with positive airway pressure device |
448 |
410 |
$6K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
484 |
421 |
$5K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
210 |
174 |
$4K |
| A7037 |
Tubing used with positive airway pressure device |
447 |
409 |
$4K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
235 |
216 |
$2K |
| E0570 |
Nebulizer, with compressor |
522 |
439 |
$2K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,251 |
991 |
$2K |
| A4452 |
Tape, waterproof, per 18 square inches |
63 |
51 |
$1K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
26 |
25 |
$814.23 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
152 |
140 |
$798.02 |
| K0003 |
Lightweight wheelchair |
57 |
53 |
$725.35 |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
14 |
13 |
$723.75 |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
18 |
13 |
$308.15 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
61 |
54 |
$182.42 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
14 |
12 |
$49.61 |