| 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 |
6,528 |
5,659 |
$462K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
1,966 |
1,508 |
$182K |
| E0570 |
Nebulizer, with compressor |
2,868 |
2,536 |
$67K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,652 |
2,263 |
$51K |
| A4554 |
Disposable underpads, all sizes |
1,209 |
956 |
$20K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
2,158 |
1,889 |
$11K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
178 |
82 |
$7K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
174 |
81 |
$7K |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
554 |
536 |
$7K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,078 |
957 |
$5K |
| K0001 |
Standard wheelchair |
254 |
211 |
$5K |
| A4259 |
Lancets, per box of 100 |
1,233 |
1,089 |
$2K |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
131 |
124 |
$2K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
29 |
12 |
$768.46 |
| A7030 |
Full face mask used with positive airway pressure device, each |
12 |
12 |
$558.61 |
| A7037 |
Tubing used with positive airway pressure device |
16 |
15 |
$397.28 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
15 |
14 |
$324.20 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
26 |
24 |
$210.06 |