| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0570 |
Nebulizer, with compressor |
440 |
423 |
$22K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
436 |
410 |
$15K |
| L8020 |
Breast prosthesis, mastectomy form |
172 |
111 |
$10K |
| 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 |
164 |
95 |
$9K |
| E0601 |
Continuous positive airway pressure (cpap) device |
72 |
56 |
$4K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
19 |
12 |
$4K |
| K0001 |
Standard wheelchair |
93 |
84 |
$3K |
| L8000 |
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
290 |
233 |
$3K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
149 |
75 |
$2K |
| L8030 |
Breast prosthesis, silicone or equal, without integral adhesive |
19 |
15 |
$2K |
| A7015 |
Aerosol mask, used with dme nebulizer |
439 |
423 |
$298.51 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
318 |
303 |
$211.79 |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
102 |
81 |
$186.01 |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
20 |
12 |
$61.64 |