| 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 |
13,853 |
12,361 |
$451K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,321 |
2,053 |
$81K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
857 |
645 |
$78K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
6,545 |
5,847 |
$71K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,604 |
1,377 |
$63K |
| K0003 |
Lightweight wheelchair |
2,983 |
2,706 |
$50K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
1,971 |
1,930 |
$48K |
| E1392 |
Portable oxygen concentrator, rental |
3,024 |
2,468 |
$29K |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
3,561 |
3,245 |
$26K |
| E0570 |
Nebulizer, with compressor |
3,422 |
3,162 |
$25K |
| 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 |
1,144 |
1,121 |
$16K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
788 |
699 |
$15K |
| 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 |
701 |
596 |
$14K |
| K0001 |
Standard wheelchair |
851 |
767 |
$12K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
356 |
241 |
$10K |
| A7037 |
Tubing used with positive airway pressure device |
807 |
635 |
$6K |
| A7035 |
Headgear used with positive airway pressure device |
571 |
443 |
$6K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
33 |
29 |
$6K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
629 |
549 |
$5K |
| A7030 |
Full face mask used with positive airway pressure device, each |
145 |
103 |
$5K |
| 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 |
595 |
584 |
$5K |
| 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) |
41 |
40 |
$4K |
| T4541 |
Incontinence product, disposable underpad, large, each |
108 |
106 |
$4K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
62 |
61 |
$3K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,428 |
1,315 |
$3K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,347 |
1,001 |
$3K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
35 |
33 |
$3K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
246 |
233 |
$3K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
105 |
78 |
$3K |
| K0007 |
Extra heavy duty wheelchair |
36 |
36 |
$2K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
396 |
308 |
$2K |
| A4927 |
Gloves, non-sterile, per 100 |
110 |
105 |
$2K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
15 |
15 |
$1K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
13 |
13 |
$1K |
| K0006 |
Heavy duty wheelchair |
12 |
12 |
$1K |
| A7031 |
Face mask interface, replacement for full face mask, each |
35 |
24 |
$884.58 |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
267 |
253 |
$861.18 |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
15 |
15 |
$775.20 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
78 |
67 |
$754.95 |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
13 |
13 |
$660.00 |
| E0245 |
Tub stool or bench |
27 |
27 |
$423.00 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
337 |
284 |
$300.83 |
| E0156 |
Seat attachment, walker |
82 |
80 |
$278.00 |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
12 |
12 |
$168.00 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
53 |
27 |
$51.57 |
| A7015 |
Aerosol mask, used with dme nebulizer |
23 |
12 |
$38.72 |