| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0466 |
Home vent non-invasive inter |
1,012 |
837 |
$374K |
| E1390 |
Oxygen concentrator |
10,678 |
8,869 |
$344K |
| A6196 |
Alginate dressing <=16 sq in |
1,090 |
821 |
$136K |
| A6266 |
Impreg gauze no h20/sal/yard |
711 |
560 |
$120K |
| E0431 |
Portable gaseous 02 |
6,943 |
5,914 |
$53K |
| E0601 |
Cont airway pressure device |
1,846 |
1,605 |
$52K |
| A7030 |
Cpap full face mask |
726 |
617 |
$36K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
383 |
286 |
$28K |
| A6446 |
Conform band s w>=3" <5"/yd |
1,048 |
834 |
$27K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
327 |
266 |
$19K |
| A6402 |
Sterile gauze <= 16 sq in |
2,311 |
1,814 |
$19K |
| A7037 |
Pos airway pressure tubing |
1,920 |
1,710 |
$17K |
| A6449 |
Lt compres band >=3" <5"/yd |
602 |
517 |
$13K |
| E0470 |
Rad w/o backup non-inv intfc |
99 |
94 |
$11K |
| A7031 |
Replacement facemask interfa |
297 |
258 |
$9K |
| A7035 |
Pos airway press headgear |
732 |
640 |
$9K |
| A7038 |
Pos airway pressure filter |
2,372 |
2,120 |
$8K |
| A7046 |
Repl water chamber, pap dev |
626 |
584 |
$6K |
| K0001 |
Standard wheelchair |
463 |
424 |
$6K |
| E0562 |
Humidifier heated used w pap |
116 |
102 |
$6K |
| A6251 |
Absorpt drg <=16 sq in w/o b |
147 |
131 |
$6K |
| A7034 |
Nasal application device |
129 |
105 |
$4K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
47 |
37 |
$4K |
| E0260 |
Hosp bed semi-electr w/ matt |
249 |
209 |
$3K |
| A4450 |
Non-waterproof tape |
667 |
539 |
$3K |
| A6219 |
Gauze <= 16 sq in w/border |
170 |
118 |
$3K |
| E2402 |
Neg press wound therapy pump |
14 |
12 |
$3K |
| E0570 |
Nebulizer with compression |
507 |
419 |
$2K |
| A7039 |
Filter, non disposable w pap |
583 |
515 |
$2K |
| A7032 |
Replacement nasal cushion |
44 |
43 |
$1K |
| E0143 |
Walker folding wheeled w/o s |
27 |
27 |
$836.96 |
| E0443 |
Portable 02 contents, gas |
17 |
13 |
$333.59 |
| A6445 |
Conform band s w <3"/yd |
17 |
12 |
$272.34 |
| K0195 |
Elevating whlchair leg rests |
21 |
13 |
$267.76 |
| E1392 |
Portable oxygen concentrator |
13 |
12 |
$235.09 |