| 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 |
14,134 |
13,629 |
$954K |
| A7030 |
Full face mask used with positive airway pressure device, each |
3,189 |
3,068 |
$227K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
240 |
195 |
$220K |
| E0601 |
Continuous positive airway pressure (cpap) device |
4,325 |
4,250 |
$190K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,483 |
1,381 |
$133K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
4,671 |
4,571 |
$127K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
250 |
231 |
$113K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
2,113 |
2,064 |
$106K |
| A7031 |
Face mask interface, replacement for full face mask, each |
2,915 |
2,822 |
$94K |
| E0570 |
Nebulizer, with compressor |
3,656 |
3,588 |
$94K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,025 |
966 |
$82K |
| A7035 |
Headgear used with positive airway pressure device |
4,481 |
4,403 |
$75K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,851 |
1,834 |
$71K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,400 |
1,250 |
$71K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
427 |
426 |
$64K |
| 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 |
4,135 |
4,055 |
$63K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
630 |
604 |
$62K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
374 |
373 |
$57K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
380 |
348 |
$55K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
304 |
304 |
$48K |
| 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) |
505 |
505 |
$46K |
| A4927 |
Gloves, non-sterile, per 100 |
3,004 |
2,614 |
$46K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
958 |
943 |
$42K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
3,336 |
3,295 |
$41K |
| K0001 |
Standard wheelchair |
2,111 |
2,042 |
$40K |
| E1392 |
Portable oxygen concentrator, rental |
2,971 |
2,939 |
$30K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,377 |
1,331 |
$27K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
5,944 |
5,746 |
$24K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
2,275 |
2,233 |
$19K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
632 |
617 |
$18K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
517 |
517 |
$17K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
73 |
73 |
$16K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
108 |
105 |
$15K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
295 |
220 |
$15K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
49 |
49 |
$13K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
662 |
658 |
$11K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
91 |
91 |
$11K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
44 |
44 |
$10K |
| E0265 |
Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress |
68 |
68 |
$10K |
| E0303 |
Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress |
78 |
78 |
$9K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
250 |
247 |
$9K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
302 |
301 |
$9K |
| A7526 |
Tracheostomy tube collar/holder, each |
241 |
229 |
$9K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
277 |
269 |
$9K |
| A7508 |
Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, each |
76 |
72 |
$8K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
64 |
64 |
$7K |
| K0007 |
Extra heavy duty wheelchair |
78 |
78 |
$7K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
40 |
40 |
$7K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
32 |
32 |
$6K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
724 |
720 |
$6K |
| K0006 |
Heavy duty wheelchair |
116 |
116 |
$6K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
128 |
128 |
$5K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
148 |
147 |
$5K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
133 |
129 |
$5K |
| E0277 |
Powered pressure-reducing air mattress |
63 |
63 |
$4K |
| A7037 |
Tubing used with positive airway pressure device |
424 |
401 |
$4K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
185 |
185 |
$4K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
127 |
121 |
$4K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
156 |
154 |
$4K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
73 |
73 |
$4K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
53 |
52 |
$4K |
| A4623 |
Tracheostomy, inner cannula |
40 |
36 |
$4K |
| K0462 |
Temporary replacement for patient owned equipment being repaired, any type |
38 |
36 |
$3K |
| E1399 |
Durable medical equipment, miscellaneous |
35 |
32 |
$3K |
| A7000 |
Canister, disposable, used with suction pump, each |
336 |
322 |
$3K |
| K0004 |
High strength, lightweight wheelchair |
46 |
46 |
$3K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
72 |
72 |
$3K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
279 |
275 |
$3K |
| A4670 |
Automatic blood pressure monitor |
62 |
62 |
$3K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
169 |
169 |
$3K |
| A7020 |
Interface for cough stimulating device, includes all components, replacement only |
74 |
74 |
$2K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
32 |
31 |
$2K |
| E0471 |
Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
12 |
12 |
$2K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
61 |
61 |
$2K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
49 |
42 |
$2K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
15 |
15 |
$2K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
164 |
158 |
$1K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
12 |
12 |
$1K |
| A7036 |
Chinstrap used with positive airway pressure device |
137 |
137 |
$1K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
264 |
264 |
$1K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
48 |
46 |
$1K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
107 |
107 |
$1K |
| E0156 |
Seat attachment, walker |
175 |
174 |
$1K |
| E0635 |
Patient lift, electric with seat or sling |
50 |
50 |
$1K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
12 |
12 |
$977.38 |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
93 |
93 |
$972.91 |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
156 |
156 |
$971.29 |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
180 |
178 |
$969.48 |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
12 |
12 |
$884.62 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
64 |
64 |
$861.89 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
115 |
113 |
$771.30 |
| E0550 |
Humidifier, durable for extensive supplemental humidification during ippb treatments or oxygen delivery |
27 |
27 |
$699.73 |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
15 |
15 |
$698.27 |
| L1812 |
Knee orthosis, elastic with joints, prefabricated, off-the-shelf |
14 |
14 |
$688.23 |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
173 |
172 |
$683.56 |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
15 |
15 |
$649.44 |
| E0940 |
Trapeze bar, free standing, complete with grab bar |
56 |
56 |
$483.18 |
| A6453 |
Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard |
218 |
215 |
$467.19 |
| A4332 |
Lubricant, individual sterile packet, each |
57 |
57 |
$451.01 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
36 |
36 |
$442.55 |
| K0003 |
Lightweight wheelchair |
13 |
13 |
$399.08 |
| A4456 |
Adhesive remover, wipes, any type, each |
49 |
49 |
$381.96 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
181 |
178 |
$364.96 |
| A5120 |
Skin barrier, wipes or swabs, each |
55 |
55 |
$327.25 |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
91 |
83 |
$321.90 |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
12 |
12 |
$250.02 |
| A7002 |
Tubing, used with suction pump, each |
50 |
49 |
$239.00 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
31 |
31 |
$225.09 |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
25 |
25 |
$184.35 |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
38 |
38 |
$182.60 |
| A7015 |
Aerosol mask, used with dme nebulizer |
78 |
78 |
$93.06 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
121 |
97 |
$21.82 |
| A7525 |
Tracheostomy mask, each |
44 |
43 |
$4.88 |