| 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 |
6,700 |
5,732 |
$401K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
567 |
462 |
$92K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
6,208 |
5,347 |
$72K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,554 |
1,416 |
$59K |
| E0619 |
Apnea monitor, with recording feature |
432 |
414 |
$55K |
| K0001 |
Standard wheelchair |
5,723 |
4,705 |
$50K |
| E0570 |
Nebulizer, with compressor |
1,442 |
1,163 |
$40K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
882 |
770 |
$31K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
527 |
467 |
$17K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
3,327 |
2,814 |
$15K |
| E0255 |
Hospital bed, variable height, hi-lo, with any type side rails, with mattress |
1,316 |
894 |
$9K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
177 |
127 |
$2K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
209 |
198 |
$2K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
52 |
37 |
$2K |
| A4322 |
Irrigation syringe, bulb or piston, each |
360 |
336 |
$2K |
| L3040 |
Foot, arch support, removable, premolded, longitudinal, each |
34 |
17 |
$2K |
| L0642 |
Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
13 |
13 |
$2K |
| A4556 |
Electrodes, (e.g., apnea monitor), per pair |
15 |
12 |
$1K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
24 |
12 |
$1K |
| A7000 |
Canister, disposable, used with suction pump, each |
25 |
24 |
$342.82 |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
15 |
13 |
$243.02 |
| E0601 |
Continuous positive airway pressure (cpap) device |
12 |
12 |
$211.76 |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
165 |
78 |
$208.55 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
191 |
174 |
$194.39 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
77 |
72 |
$158.64 |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
17 |
12 |
$47.16 |
| A7002 |
Tubing, used with suction pump, each |
13 |
12 |
$33.75 |