| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L8699 |
Prosthetic implant, not otherwise specified |
466 |
373 |
$1.36M |
| E1399 |
Durable medical equipment, miscellaneous |
1,886 |
1,351 |
$782K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
17,327 |
13,940 |
$765K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
21,887 |
20,459 |
$553K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
8,285 |
7,684 |
$431K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
4,443 |
2,169 |
$422K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
5,428 |
4,569 |
$388K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
2,520 |
2,249 |
$308K |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
1,553 |
1,375 |
$243K |
| E0601 |
Continuous positive airway pressure (cpap) device |
12,756 |
12,262 |
$227K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
10,122 |
8,507 |
$225K |
| K0001 |
Standard wheelchair |
20,279 |
18,729 |
$216K |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
2,853 |
2,595 |
$209K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
8,634 |
7,477 |
$208K |
| B9998 |
Noc for enteral supplies |
317 |
257 |
$199K |
| E1392 |
Portable oxygen concentrator, rental |
402 |
247 |
$187K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
9,173 |
7,226 |
$173K |
| 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) |
1,604 |
1,505 |
$160K |
| B9002 |
Enteral nutrition infusion pump, any type |
7,793 |
7,399 |
$155K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
623 |
600 |
$148K |
| A7030 |
Full face mask used with positive airway pressure device, each |
4,520 |
4,284 |
$144K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
5,507 |
5,252 |
$88K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
2,667 |
1,907 |
$82K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
3,314 |
3,090 |
$79K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
5,444 |
4,198 |
$77K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
16,211 |
15,515 |
$74K |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
1,799 |
1,689 |
$74K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
2,254 |
1,824 |
$64K |
| E0135 |
Walker, folding (pickup), adjustable or fixed height |
3,447 |
3,215 |
$63K |
| B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
449 |
407 |
$58K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,877 |
1,733 |
$57K |
| 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 |
956 |
895 |
$55K |
| A7035 |
Headgear used with positive airway pressure device |
9,431 |
9,001 |
$51K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,723 |
2,408 |
$50K |
| A7037 |
Tubing used with positive airway pressure device |
9,731 |
9,268 |
$47K |
| A5131 |
Appliance cleaner, incontinence and ostomy appliances, per 16 oz. |
5,921 |
5,212 |
$47K |
| 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) |
2,049 |
1,974 |
$44K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
571 |
476 |
$41K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
12,731 |
7,104 |
$40K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
6,075 |
5,409 |
$38K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
3,652 |
2,412 |
$38K |
| K0006 |
Heavy duty wheelchair |
993 |
932 |
$35K |
| E0776 |
Iv pole |
7,908 |
7,521 |
$29K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
1,050 |
972 |
$26K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
17,942 |
17,023 |
$25K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
2,497 |
2,280 |
$23K |
| A4452 |
Tape, waterproof, per 18 square inches |
5,393 |
4,748 |
$23K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
406 |
386 |
$23K |
| E0156 |
Seat attachment, walker |
1,237 |
1,153 |
$22K |
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
560 |
516 |
$20K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
3,204 |
2,993 |
$17K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
192 |
135 |
$15K |
| A4259 |
Lancets, per box of 100 |
5,506 |
4,192 |
$15K |
| E0607 |
Home blood glucose monitor |
2,171 |
1,859 |
$14K |
| A4456 |
Adhesive remover, wipes, any type, each |
6,683 |
5,816 |
$14K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
740 |
641 |
$12K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
1,760 |
1,613 |
$11K |
| A5120 |
Skin barrier, wipes or swabs, each |
6,648 |
5,807 |
$11K |
| A7526 |
Tracheostomy tube collar/holder, each |
634 |
484 |
$11K |
| A4427 |
Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each |
448 |
322 |
$10K |
| E0439 |
Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing |
54 |
53 |
$10K |
| A4371 |
Ostomy skin barrier, powder, per oz |
6,786 |
5,895 |
$9K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
3,307 |
3,109 |
$9K |
| E0186 |
Air pressure mattress |
343 |
294 |
$9K |
| A7000 |
Canister, disposable, used with suction pump, each |
2,303 |
2,050 |
$8K |
| E0277 |
Powered pressure-reducing air mattress |
235 |
200 |
$7K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
217 |
150 |
$6K |
| A7002 |
Tubing, used with suction pump, each |
2,040 |
1,813 |
$6K |
| A7036 |
Chinstrap used with positive airway pressure device |
2,517 |
2,404 |
$5K |
| A4367 |
Ostomy belt, each |
3,079 |
2,676 |
$5K |
| E0570 |
Nebulizer, with compressor |
404 |
355 |
$4K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
162 |
146 |
$3K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,535 |
1,449 |
$3K |
| K0003 |
Lightweight wheelchair |
207 |
191 |
$3K |
| A4258 |
Spring-powered device for lancet, each |
1,687 |
1,415 |
$2K |
| E0935 |
Continuous passive motion exercise device for use on knee only |
53 |
24 |
$2K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
99 |
29 |
$1K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
59 |
49 |
$1K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
34 |
24 |
$1K |
| E0434 |
Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing |
41 |
41 |
$952.97 |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
101 |
65 |
$829.05 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
186 |
182 |
$811.60 |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
104 |
80 |
$726.30 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
417 |
359 |
$650.76 |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
33 |
25 |
$535.16 |
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
28 |
25 |
$524.88 |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
232 |
102 |
$413.60 |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
12 |
12 |
$399.91 |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
69 |
24 |
$354.00 |
| A4927 |
Gloves, non-sterile, per 100 |
255 |
211 |
$187.81 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
28 |
25 |
$144.76 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
420 |
322 |
$115.12 |
| A4615 |
Cannula, nasal |
17 |
17 |
$0.00 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
14 |
13 |
$0.00 |
| E0271 |
Mattress, innerspring |
22 |
20 |
$0.00 |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
13 |
12 |
$0.00 |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
13 |
12 |
$0.00 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
14 |
13 |
$0.00 |
| A7525 |
Tracheostomy mask, each |
32 |
31 |
$0.00 |