| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
6,577 |
6,101 |
$344K |
| K0108 |
W/c component-accessory nos |
2,595 |
938 |
$180K |
| E0260 |
Hosp bed semi-electr w/ matt |
3,989 |
3,643 |
$141K |
| E0570 |
Nebulizer with compression |
3,520 |
3,423 |
$134K |
| E0603 |
Electric breast pump |
534 |
528 |
$124K |
| K0001 |
Standard wheelchair |
6,855 |
6,206 |
$122K |
| A4605 |
Trach suction cath close sys |
273 |
233 |
$93K |
| B4035 |
Enteral feed supp pump per d |
724 |
554 |
$81K |
| E1392 |
Portable oxygen concentrator |
2,610 |
2,497 |
$73K |
| A4217 |
Sterile water/saline, 500 ml |
836 |
669 |
$71K |
| K0738 |
Portable gas oxygen system |
2,909 |
2,766 |
$68K |
| E0114 |
Crutch underarm pair no wood |
1,237 |
1,217 |
$67K |
| E0601 |
Cont airway pressure device |
1,585 |
1,500 |
$57K |
| E1028 |
W/c manual swingaway |
1,106 |
670 |
$54K |
| E0466 |
Home vent non-invasive inter |
86 |
85 |
$53K |
| K0739 |
Repair/svc dme non-oxygen eq |
2,474 |
1,896 |
$46K |
| E1226 |
Manual fully reclining back |
1,591 |
1,202 |
$36K |
| B4152 |
Ef calorie dense>/=1.5kcal |
448 |
328 |
$36K |
| E0630 |
Patient lift hydraulic |
970 |
868 |
$35K |
| A7005 |
Nondisposable nebulizer set |
1,750 |
1,721 |
$30K |
| K0002 |
Stnd hemi (low seat) whlchr |
961 |
917 |
$29K |
| E0118 |
Crutch substitute |
536 |
527 |
$29K |
| E0143 |
Walker folding wheeled w/o s |
641 |
617 |
$28K |
| K0195 |
Elevating whlchair leg rests |
3,304 |
2,800 |
$28K |
| K0006 |
Heavy duty wheelchair |
522 |
500 |
$24K |
| E1236 |
Folding ped wc adjustable |
168 |
125 |
$21K |
| A7526 |
Tracheostomy tube collar |
339 |
300 |
$20K |
| L4361 |
Pneuma/vac walk boot pre ots |
72 |
71 |
$20K |
| E0973 |
W/ch access det adj armrest |
1,134 |
606 |
$19K |
| E0971 |
Wheelchair anti-tipping devi |
5,716 |
2,462 |
$15K |
| K0004 |
High strength ltwt whlchr |
196 |
165 |
$13K |
| E0245 |
Tub stool or bench |
117 |
108 |
$12K |
| E0562 |
Humidifier heated used w pap |
150 |
144 |
$11K |
| E2601 |
Gen w/c cushion wdth < 22 in |
421 |
388 |
$10K |
| L3908 |
Who cock-up nonmolde pre ots |
146 |
134 |
$9K |
| B9002 |
Enter nutr inf pump any type |
166 |
155 |
$9K |
| A4604 |
Tubing with heating element |
510 |
476 |
$9K |
| E0978 |
W/c acc,saf belt pelv strap |
2,823 |
2,256 |
$8K |
| E0470 |
Rad w/o backup non-inv intfc |
85 |
79 |
$8K |
| E0955 |
Cushioned headrest |
135 |
119 |
$7K |
| A4624 |
Tracheal suction tube |
58 |
49 |
$7K |
| E0600 |
Suction pump portab hom modl |
259 |
198 |
$6K |
| B4150 |
Ef complet w/intact nutrient |
62 |
54 |
$6K |
| A7521 |
Trach/laryn tube cuffed |
142 |
121 |
$6K |
| A7030 |
Cpap full face mask |
106 |
101 |
$4K |
| A7034 |
Nasal application device |
144 |
135 |
$4K |
| E0961 |
Wheelchair brake extension |
634 |
347 |
$3K |
| A6402 |
Sterile gauze <= 16 sq in |
394 |
320 |
$3K |
| A7031 |
Replacement facemask interfa |
142 |
133 |
$3K |
| E2361 |
22nf sealed leadacid battery |
26 |
24 |
$3K |
| L3809 |
Whfo w/o joints pre ots |
12 |
12 |
$3K |
| A4927 |
Non-sterile gloves |
168 |
129 |
$3K |
| A7035 |
Pos airway press headgear |
292 |
268 |
$3K |
| A7038 |
Pos airway pressure filter |
754 |
645 |
$2K |
| E2365 |
U1 sealed leadacid battery |
59 |
38 |
$2K |
| E2363 |
Gr24 sealed leadacid battery |
15 |
13 |
$2K |
| E0135 |
Walker folding adjust/fixed |
45 |
45 |
$2K |
| A7520 |
Trach/laryn tube non-cuffed |
54 |
52 |
$2K |
| E0776 |
Iv pole |
276 |
199 |
$2K |
| A4623 |
Tracheostomy inner cannula |
12 |
12 |
$2K |
| E0202 |
Phototherapy light w/ photom |
21 |
13 |
$2K |
| A7046 |
Repl water chamber, pap dev |
234 |
203 |
$1K |
| A4627 |
Spacer bag/reservoir |
42 |
42 |
$1K |
| E0951 |
Loop heel |
369 |
187 |
$1K |
| A7015 |
Aerosol mask used w nebulize |
839 |
821 |
$1K |
| E0155 |
Walker wheel attachment,pair |
48 |
48 |
$1K |
| K0003 |
Lightweight wheelchair |
24 |
24 |
$728.21 |
| A7032 |
Replacement nasal cushion |
12 |
12 |
$309.07 |
| A7003 |
Nebulizer administration set |
71 |
67 |
$206.50 |
| A7013 |
Disposable compressor filter |
191 |
165 |
$107.57 |
| A7002 |
Tubing used w suction pump |
12 |
12 |
$77.45 |