| 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 |
7,242 |
6,510 |
$161K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
1,496 |
1,329 |
$151K |
| E0570 |
Nebulizer, with compressor |
3,524 |
3,091 |
$125K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,848 |
1,632 |
$79K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
157 |
126 |
$27K |
| E1392 |
Portable oxygen concentrator, rental |
2,900 |
2,588 |
$22K |
| K0001 |
Standard wheelchair |
2,242 |
1,942 |
$17K |
| 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 |
1,413 |
1,273 |
$16K |
| K0002 |
Standard hemi (low seat) wheelchair |
1,301 |
1,135 |
$12K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
1,468 |
1,321 |
$11K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
6,268 |
2,878 |
$6K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,969 |
1,619 |
$5K |
| K0006 |
Heavy duty wheelchair |
26 |
25 |
$4K |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
735 |
700 |
$4K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
208 |
188 |
$3K |
| K0821 |
Power wheelchair, group 2 standard, portable, captains chair, patient weight capacity up to and including 300 pounds |
40 |
36 |
$1K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
155 |
127 |
$1K |
| A7031 |
Face mask interface, replacement for full face mask, each |
319 |
250 |
$753.04 |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
12 |
12 |
$602.52 |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
115 |
51 |
$411.59 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
36 |
25 |
$407.71 |
| E0635 |
Patient lift, electric with seat or sling |
482 |
436 |
$395.03 |
| E0277 |
Powered pressure-reducing air mattress |
27 |
26 |
$319.47 |
| A7030 |
Full face mask used with positive airway pressure device, each |
289 |
230 |
$298.23 |
| A7004 |
Small volume nonfiltered pneumatic nebulizer, disposable |
318 |
301 |
$297.89 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,153 |
898 |
$285.35 |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
119 |
52 |
$265.80 |
| A7035 |
Headgear used with positive airway pressure device |
360 |
290 |
$249.32 |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
100 |
91 |
$235.82 |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
195 |
155 |
$165.33 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
275 |
230 |
$85.13 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
30 |
24 |
$72.96 |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
43 |
37 |
$37.44 |
| A7037 |
Tubing used with positive airway pressure device |
76 |
68 |
$35.17 |
| E0271 |
Mattress, innerspring |
15 |
13 |
$16.95 |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
15 |
12 |
$0.00 |
| A9270 |
Non-covered item or service |
16 |
12 |
$0.00 |