| 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 |
8,112 |
7,402 |
$581K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
577 |
521 |
$90K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,623 |
1,478 |
$88K |
| A7030 |
Full face mask used with positive airway pressure device, each |
909 |
847 |
$79K |
| A7031 |
Face mask interface, replacement for full face mask, each |
782 |
729 |
$69K |
| 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 |
3,198 |
2,945 |
$54K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,306 |
1,092 |
$53K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,238 |
1,160 |
$38K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
378 |
304 |
$30K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
366 |
331 |
$20K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,445 |
1,338 |
$17K |
| E1392 |
Portable oxygen concentrator, rental |
1,597 |
1,488 |
$16K |
| E0570 |
Nebulizer, with compressor |
1,526 |
1,375 |
$16K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
671 |
624 |
$16K |
| A7035 |
Headgear used with positive airway pressure device |
869 |
802 |
$14K |
| K0001 |
Standard wheelchair |
580 |
508 |
$12K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,651 |
1,501 |
$7K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
467 |
460 |
$6K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
390 |
350 |
$4K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
385 |
360 |
$3K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
24 |
24 |
$3K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
112 |
105 |
$2K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
89 |
52 |
$2K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
142 |
113 |
$1K |
| K0006 |
Heavy duty wheelchair |
19 |
13 |
$888.88 |
| A7037 |
Tubing used with positive airway pressure device |
31 |
24 |
$500.33 |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
12 |
12 |
$406.42 |
| K0003 |
Lightweight wheelchair |
14 |
13 |
$238.71 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
13 |
12 |
$97.55 |