| 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 |
8,654 |
6,256 |
$414K |
| 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 |
3,183 |
2,144 |
$195K |
| E0601 |
Continuous positive airway pressure (cpap) device |
5,194 |
3,853 |
$176K |
| E0570 |
Nebulizer, with compressor |
5,364 |
4,269 |
$159K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
1,779 |
1,134 |
$124K |
| A4554 |
Disposable underpads, all sizes |
4,253 |
2,813 |
$121K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,547 |
1,195 |
$107K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
4,990 |
3,826 |
$56K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
779 |
647 |
$51K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
5,402 |
3,839 |
$42K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,397 |
933 |
$36K |
| A7035 |
Headgear used with positive airway pressure device |
2,297 |
1,766 |
$31K |
| A4927 |
Gloves, non-sterile, per 100 |
2,145 |
1,206 |
$26K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,329 |
977 |
$26K |
| A7037 |
Tubing used with positive airway pressure device |
1,157 |
958 |
$25K |
| T2025 |
Waiver services; not otherwise specified (nos) |
519 |
465 |
$18K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
633 |
422 |
$16K |
| K0001 |
Standard wheelchair |
1,357 |
964 |
$15K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
318 |
258 |
$14K |
| S5161 |
Emergency response system; service fee, per month (excludes installation and testing) |
592 |
503 |
$12K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
156 |
132 |
$9K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
406 |
279 |
$8K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,566 |
1,991 |
$5K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
113 |
94 |
$4K |
| E1392 |
Portable oxygen concentrator, rental |
302 |
225 |
$4K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
605 |
445 |
$3K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
72 |
56 |
$2K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
14 |
14 |
$833.59 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
76 |
57 |
$356.06 |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
36 |
21 |
$278.14 |
| K0003 |
Lightweight wheelchair |
20 |
12 |
$220.91 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
49 |
48 |
$121.52 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
65 |
38 |
$91.62 |
| A7015 |
Aerosol mask, used with dme nebulizer |
49 |
48 |
$85.81 |