| 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 |
2,789 |
2,763 |
$196K |
| A4554 |
Disposable underpads, all sizes |
4,410 |
4,385 |
$143K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,216 |
1,212 |
$139K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
691 |
686 |
$97K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,786 |
1,740 |
$76K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
496 |
476 |
$51K |
| E0601 |
Continuous positive airway pressure (cpap) device |
692 |
686 |
$35K |
| E0570 |
Nebulizer, with compressor |
469 |
463 |
$35K |
| A4335 |
Incontinence supply; miscellaneous |
6,104 |
6,062 |
$32K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,670 |
1,653 |
$23K |
| K0001 |
Standard wheelchair |
1,338 |
1,336 |
$20K |
| K0003 |
Lightweight wheelchair |
524 |
515 |
$16K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
624 |
621 |
$13K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
243 |
239 |
$4K |
| B9998 |
Noc for enteral supplies |
61 |
50 |
$4K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
296 |
295 |
$1K |
| A7030 |
Full face mask used with positive airway pressure device, each |
14 |
14 |
$1K |
| A7031 |
Face mask interface, replacement for full face mask, each |
29 |
29 |
$990.74 |
| A7015 |
Aerosol mask, used with dme nebulizer |
590 |
581 |
$656.53 |
| A7035 |
Headgear used with positive airway pressure device |
42 |
42 |
$561.65 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
12 |
12 |
$352.82 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
37 |
37 |
$344.17 |
| A4245 |
Alcohol wipes, per box |
62 |
62 |
$207.58 |
| A7037 |
Tubing used with positive airway pressure device |
13 |
13 |
$206.11 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
288 |
284 |
$140.45 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
37 |
36 |
$109.52 |