| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
3,214 |
2,958 |
$343K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
4,932 |
4,622 |
$155K |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
718 |
625 |
$87K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,682 |
1,569 |
$81K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
1,319 |
1,082 |
$56K |
| A7030 |
Full face mask used with positive airway pressure device, each |
496 |
468 |
$55K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
167 |
137 |
$40K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
436 |
346 |
$40K |
| E1392 |
Portable oxygen concentrator, rental |
3,276 |
3,083 |
$38K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,149 |
1,061 |
$36K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,776 |
1,652 |
$33K |
| A7031 |
Face mask interface, replacement for full face mask, each |
869 |
811 |
$29K |
| E0570 |
Nebulizer, with compressor |
343 |
310 |
$20K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
443 |
384 |
$18K |
| A7035 |
Headgear used with positive airway pressure device |
874 |
805 |
$14K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
291 |
269 |
$7K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,736 |
1,569 |
$6K |
| K0001 |
Standard wheelchair |
207 |
197 |
$4K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
318 |
287 |
$3K |
| A4565 |
Slings |
152 |
142 |
$1K |
| A4554 |
Disposable underpads, all sizes |
37 |
36 |
$1K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
106 |
95 |
$359.87 |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
40 |
36 |
$95.23 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
21 |
12 |
$34.08 |
| A4615 |
Cannula, nasal |
43 |
27 |
$5.12 |