| 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 |
2,778 |
2,601 |
$248K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,299 |
2,132 |
$93K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
722 |
710 |
$93K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
540 |
528 |
$67K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
658 |
642 |
$63K |
| S5161 |
Emergency response system; service fee, per month (excludes installation and testing) |
1,260 |
1,175 |
$62K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
377 |
374 |
$62K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
300 |
255 |
$62K |
| E1392 |
Portable oxygen concentrator, rental |
1,508 |
1,407 |
$52K |
| E0570 |
Nebulizer, with compressor |
1,830 |
1,737 |
$48K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
268 |
265 |
$41K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
949 |
906 |
$36K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
657 |
643 |
$34K |
| T4541 |
Incontinence product, disposable underpad, large, each |
569 |
562 |
$30K |
| A7030 |
Full face mask used with positive airway pressure device, each |
265 |
245 |
$23K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
338 |
321 |
$20K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
82 |
81 |
$19K |
| 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 |
495 |
463 |
$18K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
277 |
252 |
$17K |
| A7035 |
Headgear used with positive airway pressure device |
808 |
763 |
$16K |
| A7031 |
Face mask interface, replacement for full face mask, each |
381 |
351 |
$12K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,219 |
2,130 |
$11K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
570 |
552 |
$10K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
132 |
126 |
$9K |
| A4927 |
Gloves, non-sterile, per 100 |
286 |
259 |
$9K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
163 |
148 |
$8K |
| K0001 |
Standard wheelchair |
272 |
248 |
$6K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
26 |
25 |
$5K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
393 |
374 |
$5K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
28 |
28 |
$5K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
124 |
123 |
$4K |
| A4670 |
Automatic blood pressure monitor |
53 |
52 |
$3K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
66 |
46 |
$3K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
15 |
15 |
$3K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
50 |
50 |
$3K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
14 |
14 |
$3K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
79 |
76 |
$2K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
12 |
12 |
$1K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
13 |
13 |
$832.14 |
| A4452 |
Tape, waterproof, per 18 square inches |
14 |
12 |
$803.77 |
| E1399 |
Durable medical equipment, miscellaneous |
15 |
13 |
$236.91 |
| A7015 |
Aerosol mask, used with dme nebulizer |
56 |
56 |
$80.24 |