| 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 |
143 |
139 |
$2K |
| E0295 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress |
173 |
152 |
$729.97 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
13 |
12 |
$238.40 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
55 |
55 |
$148.15 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
30 |
28 |
$40.38 |
| A4258 |
Spring-powered device for lancet, each |
32 |
28 |
$2.97 |