| 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 |
1,860 |
1,840 |
$157K |
| 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 |
1,509 |
1,483 |
$107K |
| E0601 |
Continuous positive airway pressure (cpap) device |
924 |
907 |
$54K |
| A7030 |
Full face mask used with positive airway pressure device, each |
501 |
491 |
$40K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,186 |
1,150 |
$22K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
371 |
364 |
$21K |
| A7037 |
Tubing used with positive airway pressure device |
538 |
527 |
$17K |
| E0570 |
Nebulizer, with compressor |
271 |
264 |
$16K |
| A7035 |
Headgear used with positive airway pressure device |
558 |
552 |
$13K |
| K0001 |
Standard wheelchair |
383 |
383 |
$9K |
| A7031 |
Face mask interface, replacement for full face mask, each |
256 |
245 |
$8K |
| E0561 |
Humidifier, non-heated, used with positive airway pressure device |
911 |
885 |
$8K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,420 |
1,371 |
$7K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
31 |
31 |
$4K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
171 |
171 |
$3K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
296 |
295 |
$2K |
| E0470 |
Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
16 |
12 |
$1K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
108 |
108 |
$1K |
| 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 |
39 |
38 |
$301.68 |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
14 |
13 |
$262.14 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
13 |
13 |
$191.45 |