| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0439 |
Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing |
5,895 |
5,886 |
$294K |
| E0601 |
Continuous positive airway pressure (cpap) device |
5,899 |
5,890 |
$218K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,935 |
2,924 |
$198K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,272 |
2,264 |
$144K |
| B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
277 |
276 |
$138K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,226 |
1,224 |
$123K |
| E0570 |
Nebulizer, with compressor |
6,084 |
6,084 |
$120K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,290 |
1,287 |
$96K |
| A7031 |
Face mask interface, replacement for full face mask, each |
3,535 |
3,531 |
$82K |
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
647 |
647 |
$79K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
777 |
758 |
$68K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
625 |
621 |
$67K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
697 |
694 |
$62K |
| A7037 |
Tubing used with positive airway pressure device |
4,433 |
4,421 |
$54K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,017 |
1,013 |
$53K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,093 |
1,089 |
$52K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,510 |
1,506 |
$52K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
979 |
968 |
$49K |
| E0434 |
Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing |
5,864 |
5,852 |
$47K |
| A7035 |
Headgear used with positive airway pressure device |
3,535 |
3,522 |
$46K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,680 |
1,674 |
$44K |
| K0001 |
Standard wheelchair |
2,837 |
2,829 |
$43K |
| E0442 |
Stationary oxygen contents, liquid, 1 month's supply = 1 unit |
2,752 |
2,745 |
$38K |
| E0444 |
Portable oxygen contents, liquid, 1 month's supply = 1 unit |
2,592 |
2,583 |
$33K |
| A4927 |
Gloves, non-sterile, per 100 |
1,221 |
1,208 |
$29K |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
234 |
228 |
$29K |
| 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 |
1,281 |
1,278 |
$27K |
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
153 |
152 |
$24K |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
1,894 |
1,891 |
$24K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
7,524 |
7,503 |
$23K |
| 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) |
311 |
311 |
$17K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
2,303 |
2,297 |
$17K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
884 |
873 |
$9K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
169 |
167 |
$8K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
352 |
350 |
$8K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
196 |
196 |
$7K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
145 |
145 |
$4K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
37 |
37 |
$3K |
| M0201 |
Administration of pneumococcal, influenza, hepatitis b, and/or covid-19 vaccine inside a patient's home; reported only once per individual home per date of service when such vaccine administration(s) are performed at the patient's home |
88 |
88 |
$2K |
| A4456 |
Adhesive remover, wipes, any type, each |
241 |
238 |
$2K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
24 |
24 |
$2K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
185 |
182 |
$1K |
| 91322 |
|
29 |
29 |
$1K |
| 90694 |
|
118 |
118 |
$1K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
78 |
78 |
$1K |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
392 |
387 |
$1K |
| A4670 |
Automatic blood pressure monitor |
14 |
14 |
$889.98 |
| 0124A |
|
38 |
38 |
$605.38 |
| 90480 |
|
33 |
33 |
$582.21 |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
19 |
12 |
$553.00 |
| 0134A |
|
15 |
15 |
$200.76 |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
12 |
12 |
$190.99 |
| A4371 |
Ostomy skin barrier, powder, per oz |
25 |
25 |
$56.99 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
14 |
14 |
$53.65 |
| G0008 |
Administration of influenza virus vaccine |
239 |
239 |
$0.00 |
| 90688 |
|
82 |
82 |
$0.00 |
| 90653 |
|
17 |
17 |
$0.00 |