| 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 |
6,043 |
6,002 |
$420K |
| E0570 |
Nebulizer, with compressor |
2,849 |
2,835 |
$123K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
4,650 |
4,598 |
$102K |
| K0003 |
Lightweight wheelchair |
1,380 |
1,367 |
$43K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
818 |
816 |
$33K |
| E0601 |
Continuous positive airway pressure (cpap) device |
577 |
569 |
$27K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,473 |
1,465 |
$21K |
| T4541 |
Incontinence product, disposable underpad, large, each |
245 |
243 |
$11K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
205 |
204 |
$11K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
148 |
145 |
$5K |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
549 |
540 |
$5K |
| A4670 |
Automatic blood pressure monitor |
38 |
38 |
$2K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
311 |
307 |
$1K |
| A7030 |
Full face mask used with positive airway pressure device, each |
12 |
12 |
$770.08 |
| A7015 |
Aerosol mask, used with dme nebulizer |
587 |
585 |
$651.73 |
| A7037 |
Tubing used with positive airway pressure device |
52 |
52 |
$578.00 |
| A7031 |
Face mask interface, replacement for full face mask, each |
25 |
25 |
$564.56 |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
18 |
12 |
$536.68 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
24 |
24 |
$368.18 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
12 |
12 |
$332.15 |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
15 |
15 |
$178.99 |
| A7035 |
Headgear used with positive airway pressure device |
12 |
12 |
$138.92 |
| E0156 |
Seat attachment, walker |
12 |
12 |
$107.92 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
23 |
23 |
$6.84 |