| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
1,012 |
837 |
$374K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
10,678 |
8,869 |
$344K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
1,090 |
821 |
$136K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
711 |
560 |
$120K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
6,943 |
5,914 |
$53K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,846 |
1,605 |
$52K |
| A7030 |
Full face mask used with positive airway pressure device, each |
726 |
617 |
$36K |
| 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 |
383 |
286 |
$28K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
1,048 |
834 |
$27K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
327 |
266 |
$19K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,311 |
1,814 |
$19K |
| A7037 |
Tubing used with positive airway pressure device |
1,920 |
1,710 |
$17K |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
602 |
517 |
$13K |
| E0470 |
Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
99 |
94 |
$11K |
| A7031 |
Face mask interface, replacement for full face mask, each |
297 |
258 |
$9K |
| A7035 |
Headgear used with positive airway pressure device |
732 |
640 |
$9K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,372 |
2,120 |
$8K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
626 |
584 |
$6K |
| K0001 |
Standard wheelchair |
463 |
424 |
$6K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
116 |
102 |
$6K |
| A6251 |
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
147 |
131 |
$6K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
129 |
105 |
$4K |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
47 |
37 |
$4K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
249 |
209 |
$3K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
667 |
539 |
$3K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
170 |
118 |
$3K |
| E2402 |
Negative pressure wound therapy electrical pump, stationary or portable |
14 |
12 |
$3K |
| E0570 |
Nebulizer, with compressor |
507 |
419 |
$2K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
583 |
515 |
$2K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
44 |
43 |
$1K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
27 |
27 |
$836.96 |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
17 |
13 |
$333.59 |
| A6445 |
Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard |
17 |
12 |
$272.34 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
21 |
13 |
$267.76 |
| E1392 |
Portable oxygen concentrator, rental |
13 |
12 |
$235.09 |