| 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 |
5,058 |
4,828 |
$429K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
3,049 |
2,831 |
$294K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,051 |
1,949 |
$198K |
| E0601 |
Continuous positive airway pressure (cpap) device |
4,704 |
4,418 |
$188K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
1,354 |
1,127 |
$160K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
3,678 |
3,490 |
$144K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,117 |
1,030 |
$115K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
453 |
445 |
$105K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,849 |
1,702 |
$104K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,129 |
1,012 |
$90K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,346 |
1,296 |
$86K |
| 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) |
501 |
477 |
$67K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,625 |
1,533 |
$61K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
535 |
477 |
$61K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
249 |
244 |
$60K |
| A7035 |
Headgear used with positive airway pressure device |
2,597 |
2,482 |
$54K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
299 |
280 |
$49K |
| E0570 |
Nebulizer, with compressor |
915 |
876 |
$44K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,057 |
988 |
$40K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
489 |
451 |
$29K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
5,945 |
5,679 |
$27K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
604 |
580 |
$20K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,402 |
1,351 |
$19K |
| E1392 |
Portable oxygen concentrator, rental |
533 |
521 |
$18K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,025 |
986 |
$18K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
137 |
132 |
$17K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
94 |
87 |
$14K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
222 |
200 |
$13K |
| K0001 |
Standard wheelchair |
449 |
424 |
$12K |
| 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 |
322 |
290 |
$9K |
| L0621 |
Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf |
78 |
77 |
$6K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
27 |
25 |
$5K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
268 |
245 |
$4K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
42 |
42 |
$3K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
49 |
49 |
$3K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
41 |
37 |
$2K |
| A4670 |
Automatic blood pressure monitor |
27 |
27 |
$2K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
20 |
13 |
$1K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
159 |
148 |
$1K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
31 |
31 |
$728.90 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
331 |
315 |
$702.65 |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
69 |
62 |
$650.68 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
67 |
55 |
$372.66 |