| 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 |
5,614 |
5,136 |
$231K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,608 |
1,449 |
$59K |
| E0570 |
Nebulizer, with compressor |
1,825 |
1,689 |
$46K |
| K0003 |
Lightweight wheelchair |
922 |
846 |
$36K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,554 |
2,234 |
$36K |
| E1392 |
Portable oxygen concentrator, rental |
958 |
869 |
$14K |
| A7030 |
Full face mask used with positive airway pressure device, each |
397 |
323 |
$13K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
234 |
211 |
$13K |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
999 |
951 |
$11K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
287 |
242 |
$8K |
| A7031 |
Face mask interface, replacement for full face mask, each |
202 |
168 |
$7K |
| A7035 |
Headgear used with positive airway pressure device |
460 |
371 |
$6K |
| K0001 |
Standard wheelchair |
277 |
251 |
$6K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
75 |
60 |
$6K |
| T4541 |
Incontinence product, disposable underpad, large, each |
198 |
166 |
$5K |
| A7037 |
Tubing used with positive airway pressure device |
478 |
401 |
$4K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
113 |
97 |
$4K |
| 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 |
148 |
138 |
$3K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
42 |
34 |
$3K |
| A4927 |
Gloves, non-sterile, per 100 |
233 |
187 |
$2K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
926 |
715 |
$2K |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
19 |
13 |
$2K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
266 |
222 |
$1K |
| 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) |
15 |
13 |
$1K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
82 |
79 |
$1K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
14 |
12 |
$804.00 |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
14 |
12 |
$402.00 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
253 |
232 |
$383.75 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
59 |
52 |
$317.68 |
| A7015 |
Aerosol mask, used with dme nebulizer |
14 |
14 |
$54.47 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
44 |
25 |
$25.74 |