| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1161 |
Manual adult size wheelchair, includes tilt in space |
732 |
610 |
$265K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
6,941 |
6,062 |
$225K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
2,116 |
1,248 |
$218K |
| A4554 |
Disposable underpads, all sizes |
2,523 |
2,343 |
$171K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,397 |
1,273 |
$119K |
| A4927 |
Gloves, non-sterile, per 100 |
3,295 |
2,943 |
$113K |
| E0601 |
Continuous positive airway pressure (cpap) device |
5,124 |
4,226 |
$110K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,411 |
1,300 |
$108K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
4,166 |
3,605 |
$77K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,769 |
1,522 |
$52K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,671 |
1,397 |
$40K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
989 |
860 |
$34K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
137 |
61 |
$25K |
| E0570 |
Nebulizer, with compressor |
964 |
877 |
$18K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
714 |
623 |
$17K |
| 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) |
297 |
243 |
$16K |
| E2311 |
Power wheelchair accessory, electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware |
14 |
12 |
$14K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
196 |
173 |
$13K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
211 |
135 |
$12K |
| A7035 |
Headgear used with positive airway pressure device |
2,030 |
1,776 |
$11K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,691 |
1,415 |
$11K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,350 |
1,145 |
$10K |
| K0040 |
Adjustable angle footplate, each |
288 |
161 |
$9K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
308 |
274 |
$8K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,831 |
2,361 |
$8K |
| A7037 |
Tubing used with positive airway pressure device |
645 |
588 |
$6K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
87 |
73 |
$5K |
| K0001 |
Standard wheelchair |
623 |
515 |
$4K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
101 |
66 |
$4K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
25 |
25 |
$4K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
86 |
73 |
$972.37 |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
111 |
89 |
$877.95 |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
28 |
14 |
$273.92 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
94 |
79 |
$268.55 |
| E2211 |
Manual wheelchair accessory, pneumatic propulsion tire, any size, each |
18 |
14 |
$262.08 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
14 |
12 |
$61.31 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
80 |
65 |
$2.86 |
| E2620 |
Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware |
12 |
12 |
$0.00 |