| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
2,818 |
2,541 |
$178K |
| A6196 |
Alginate dressing <=16 sq in |
323 |
267 |
$39K |
| E0601 |
Cont airway pressure device |
705 |
627 |
$24K |
| E0431 |
Portable gaseous 02 |
1,370 |
1,240 |
$19K |
| A6266 |
Impreg gauze no h20/sal/yard |
150 |
132 |
$11K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
105 |
88 |
$6K |
| E0562 |
Humidifier heated used w pap |
207 |
180 |
$4K |
| A6197 |
Alginate drsg >16 <=48 sq in |
15 |
12 |
$4K |
| A6021 |
Collagen dressing <=16 sq in |
14 |
12 |
$3K |
| A6216 |
Non-sterile gauze<=16 sq in |
470 |
432 |
$3K |
| A4452 |
Waterproof tape |
166 |
147 |
$2K |
| A6446 |
Conform band s w>=3" <5"/yd |
46 |
41 |
$1K |
| A4450 |
Non-waterproof tape |
342 |
305 |
$975.66 |
| A6402 |
Sterile gauze <= 16 sq in |
137 |
121 |
$724.88 |
| A7038 |
Pos airway pressure filter |
82 |
75 |
$292.83 |
| A7037 |
Pos airway pressure tubing |
12 |
12 |
$178.61 |