| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
18,438 |
17,522 |
$1.25M |
| E0465 |
Home vent invasive interface |
833 |
641 |
$637K |
| E0260 |
Hosp bed semi-electr w/ matt |
8,246 |
7,769 |
$340K |
| A7030 |
Cpap full face mask |
3,376 |
3,283 |
$281K |
| K0001 |
Standard wheelchair |
10,819 |
10,206 |
$259K |
| A4217 |
Sterile water/saline, 500 ml |
3,390 |
2,135 |
$234K |
| E0570 |
Nebulizer with compression |
5,881 |
5,735 |
$225K |
| K0738 |
Portable gas oxygen system |
10,186 |
9,699 |
$217K |
| K0108 |
W/c component-accessory nos |
2,907 |
1,174 |
$182K |
| A4604 |
Tubing with heating element |
4,744 |
4,576 |
$164K |
| A7034 |
Nasal application device |
2,774 |
2,674 |
$152K |
| E0202 |
Phototherapy light w/ photom |
933 |
825 |
$134K |
| E1392 |
Portable oxygen concentrator |
4,622 |
4,369 |
$133K |
| E0466 |
Home vent non-invasive inter |
211 |
211 |
$108K |
| E0973 |
W/ch access det adj armrest |
11,974 |
6,235 |
$95K |
| E0601 |
Cont airway pressure device |
1,962 |
1,881 |
$93K |
| B4035 |
Enteral feed supp pump per d |
1,063 |
928 |
$88K |
| A7031 |
Replacement facemask interfa |
1,733 |
1,602 |
$84K |
| K0739 |
Repair/svc dme non-oxygen eq |
3,974 |
3,179 |
$82K |
| A7035 |
Pos airway press headgear |
4,056 |
3,917 |
$75K |
| A4605 |
Trach suction cath close sys |
303 |
265 |
$73K |
| E0603 |
Electric breast pump |
364 |
328 |
$54K |
| K0195 |
Elevating whlchair leg rests |
3,975 |
3,615 |
$49K |
| A7005 |
Nondisposable nebulizer set |
2,038 |
2,001 |
$43K |
| E1226 |
Manual fully reclining back |
1,235 |
1,126 |
$43K |
| A7038 |
Pos airway pressure filter |
6,880 |
5,493 |
$41K |
| A7526 |
Tracheostomy tube collar |
622 |
563 |
$38K |
| E1028 |
W/c manual swingaway |
1,655 |
1,299 |
$34K |
| K0823 |
Pwc gp 2 std cap chair |
158 |
149 |
$31K |
| E0118 |
Crutch substitute |
707 |
659 |
$31K |
| A7046 |
Repl water chamber, pap dev |
2,139 |
2,058 |
$28K |
| E0971 |
Wheelchair anti-tipping devi |
4,848 |
2,809 |
$25K |
| A4618 |
Breathing circuits |
1,201 |
937 |
$24K |
| E0630 |
Patient lift hydraulic |
1,267 |
1,236 |
$22K |
| A7032 |
Replacement nasal cushion |
363 |
331 |
$21K |
| E0604 |
Hosp grade elec breast pump |
745 |
669 |
$20K |
| E0434 |
Portable liquid 02 |
843 |
785 |
$16K |
| A7521 |
Trach/laryn tube cuffed |
497 |
434 |
$16K |
| E0114 |
Crutch underarm pair no wood |
352 |
342 |
$13K |
| A7039 |
Filter, non disposable w pap |
1,415 |
1,358 |
$11K |
| K0002 |
Stnd hemi (low seat) whlchr |
292 |
285 |
$11K |
| E0978 |
W/c acc,saf belt pelv strap |
2,354 |
2,136 |
$10K |
| K0003 |
Lightweight wheelchair |
365 |
359 |
$9K |
| A7037 |
Pos airway pressure tubing |
575 |
567 |
$8K |
| A6402 |
Sterile gauze <= 16 sq in |
794 |
595 |
$7K |
| B4152 |
Ef calorie dense>/=1.5kcal |
295 |
252 |
$6K |
| E0143 |
Walker folding wheeled w/o s |
371 |
341 |
$6K |
| A4927 |
Non-sterile gloves |
451 |
255 |
$5K |
| A7003 |
Nebulizer administration set |
1,392 |
1,299 |
$4K |
| E0990 |
Wheelchair elevating leg res |
505 |
406 |
$3K |
| A7033 |
Replacement nasal pillows |
26 |
25 |
$2K |
| K0004 |
High strength ltwt whlchr |
116 |
115 |
$2K |
| E0277 |
Powered pres-redu air mattrs |
52 |
49 |
$1K |
| B9002 |
Enter nutr inf pump any type |
141 |
127 |
$1K |
| A7006 |
Filtered nebulizer admin set |
118 |
112 |
$1K |
| E1161 |
Manual adult wc w tiltinspac |
24 |
24 |
$959.72 |
| E0439 |
Stationary liquid 02 |
145 |
126 |
$816.21 |
| A7013 |
Disposable compressor filter |
660 |
525 |
$755.99 |
| E1399 |
Durable medical equipment mi |
70 |
48 |
$638.51 |
| E0245 |
Tub stool or bench |
13 |
12 |
$512.08 |
| E0961 |
Wheelchair brake extension |
66 |
39 |
$508.31 |
| A7015 |
Aerosol mask used w nebulize |
307 |
300 |
$467.85 |
| E0776 |
Iv pole |
250 |
220 |
$444.37 |
| E2361 |
22nf sealed leadacid battery |
43 |
26 |
$371.12 |
| E0431 |
Portable gaseous 02 |
13 |
13 |
$358.65 |
| A7004 |
Disposable nebulizer sml vol |
584 |
577 |
$343.29 |
| A4213 |
20+ cc syringe only |
137 |
130 |
$236.61 |
| B4150 |
Ef complet w/intact nutrient |
14 |
13 |
$232.55 |
| E0550 |
Humidif extens supple w ippb |
13 |
12 |
$143.03 |
| E0181 |
Press pad alternating w/ pum |
12 |
12 |
$141.67 |
| A7000 |
Disposable canister for pump |
13 |
12 |
$105.46 |
| E2365 |
U1 sealed leadacid battery |
201 |
105 |
$0.00 |
| A4627 |
Spacer bag/reservoir |
14 |
14 |
$0.00 |
| E0203 |
Therapeutic lightbox tabletp |
126 |
117 |
$0.00 |