| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
4,035 |
3,070 |
$121K |
| E0601 |
Cont airway pressure device |
1,836 |
1,545 |
$38K |
| A6196 |
Alginate dressing <=16 sq in |
187 |
160 |
$28K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
376 |
315 |
$28K |
| E0466 |
Home vent non-invasive inter |
23 |
17 |
$21K |
| E0431 |
Portable gaseous 02 |
1,882 |
1,451 |
$12K |
| E0562 |
Humidifier heated used w pap |
939 |
791 |
$12K |
| A6212 |
Foam drg <=16 sq in w/border |
184 |
124 |
$10K |
| A7030 |
Cpap full face mask |
162 |
152 |
$9K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
120 |
98 |
$7K |
| A7035 |
Pos airway press headgear |
448 |
410 |
$6K |
| A6402 |
Sterile gauze <= 16 sq in |
484 |
421 |
$5K |
| A6446 |
Conform band s w>=3" <5"/yd |
210 |
174 |
$4K |
| A7037 |
Pos airway pressure tubing |
447 |
409 |
$4K |
| A7046 |
Repl water chamber, pap dev |
235 |
216 |
$2K |
| E0570 |
Nebulizer with compression |
522 |
439 |
$2K |
| A7038 |
Pos airway pressure filter |
1,251 |
991 |
$2K |
| A4452 |
Waterproof tape |
63 |
51 |
$1K |
| A4604 |
Tubing with heating element |
26 |
25 |
$814.23 |
| A4450 |
Non-waterproof tape |
152 |
140 |
$798.02 |
| K0003 |
Lightweight wheelchair |
57 |
53 |
$725.35 |
| A7034 |
Nasal application device |
14 |
13 |
$723.75 |
| A7032 |
Replacement nasal cushion |
18 |
13 |
$308.15 |
| K0195 |
Elevating whlchair leg rests |
61 |
54 |
$182.42 |
| A7039 |
Filter, non disposable w pap |
14 |
12 |
$49.61 |