| 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 |
2,085 |
1,938 |
$89K |
| E0570 |
Nebulizer, with compressor |
1,648 |
1,483 |
$55K |
| E0601 |
Continuous positive airway pressure (cpap) device |
978 |
911 |
$27K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
790 |
706 |
$26K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,517 |
1,384 |
$23K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,327 |
1,220 |
$9K |
| K0001 |
Standard wheelchair |
411 |
366 |
$5K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,063 |
793 |
$4K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
25 |
24 |
$4K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
26 |
25 |
$3K |
| E1392 |
Portable oxygen concentrator, rental |
207 |
194 |
$3K |
| A4259 |
Lancets, per box of 100 |
1,091 |
998 |
$3K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
16 |
12 |
$1K |
| A7031 |
Face mask interface, replacement for full face mask, each |
40 |
37 |
$947.06 |
| 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 |
30 |
12 |
$765.00 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
317 |
232 |
$415.05 |
| A7015 |
Aerosol mask, used with dme nebulizer |
236 |
170 |
$231.46 |
| A7035 |
Headgear used with positive airway pressure device |
14 |
13 |
$108.41 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
278 |
197 |
$105.72 |
| 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 |
30 |
12 |
$0.00 |