| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
1,034 |
1,001 |
$260K |
| L1833 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
391 |
379 |
$163K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
363 |
353 |
$76K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,496 |
1,469 |
$66K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
888 |
852 |
$57K |
| E0570 |
Nebulizer, with compressor |
1,714 |
1,658 |
$56K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
815 |
723 |
$53K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
668 |
660 |
$42K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,031 |
1,020 |
$41K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
200 |
192 |
$40K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
264 |
258 |
$39K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
709 |
702 |
$38K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
305 |
296 |
$37K |
| A7030 |
Full face mask used with positive airway pressure device, each |
407 |
404 |
$37K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
432 |
419 |
$32K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
280 |
267 |
$29K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
170 |
168 |
$25K |
| T4541 |
Incontinence product, disposable underpad, large, each |
430 |
416 |
$22K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
393 |
369 |
$21K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
383 |
374 |
$20K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
222 |
215 |
$20K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
323 |
309 |
$18K |
| A7035 |
Headgear used with positive airway pressure device |
701 |
696 |
$14K |
| L3040 |
Foot, arch support, removable, premolded, longitudinal, each |
283 |
257 |
$12K |
| A7031 |
Face mask interface, replacement for full face mask, each |
331 |
328 |
$12K |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
325 |
319 |
$11K |
| E1392 |
Portable oxygen concentrator, rental |
331 |
317 |
$11K |
| K0001 |
Standard wheelchair |
439 |
418 |
$11K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
316 |
307 |
$8K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
52 |
49 |
$8K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
253 |
250 |
$8K |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
155 |
154 |
$7K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
471 |
465 |
$6K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,298 |
1,274 |
$6K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
239 |
233 |
$5K |
| 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 |
48 |
39 |
$4K |
| A4927 |
Gloves, non-sterile, per 100 |
96 |
82 |
$3K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
710 |
687 |
$1K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
12 |
12 |
$1K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
27 |
24 |
$988.55 |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
15 |
14 |
$892.43 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
51 |
49 |
$770.24 |
| K0003 |
Lightweight wheelchair |
15 |
13 |
$650.62 |