| 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 |
13,905 |
13,290 |
$585K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
11,221 |
10,796 |
$86K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,343 |
1,270 |
$38K |
| A7030 |
Full face mask used with positive airway pressure device, each |
554 |
546 |
$27K |
| K0001 |
Standard wheelchair |
2,107 |
1,948 |
$25K |
| A7031 |
Face mask interface, replacement for full face mask, each |
767 |
733 |
$19K |
| E0570 |
Nebulizer, with compressor |
482 |
467 |
$17K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
107 |
102 |
$16K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
370 |
363 |
$15K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
907 |
890 |
$12K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
329 |
319 |
$12K |
| 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) |
205 |
202 |
$10K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
360 |
359 |
$9K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
384 |
331 |
$7K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,360 |
2,238 |
$6K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
170 |
168 |
$5K |
| A7035 |
Headgear used with positive airway pressure device |
561 |
552 |
$5K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
565 |
551 |
$5K |
| E1392 |
Portable oxygen concentrator, rental |
327 |
313 |
$4K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
576 |
567 |
$4K |
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 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 |
410 |
312 |
$4K |
| A7037 |
Tubing used with positive airway pressure device |
469 |
463 |
$3K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
70 |
68 |
$2K |
| E0471 |
Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
26 |
26 |
$2K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
42 |
42 |
$2K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
371 |
354 |
$2K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
94 |
83 |
$2K |
| B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
120 |
109 |
$2K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
664 |
643 |
$1K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
232 |
225 |
$855.70 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
326 |
312 |
$743.61 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
42 |
42 |
$660.97 |
| A4649 |
Surgical supply; miscellaneous |
449 |
209 |
$315.62 |
| A7526 |
Tracheostomy tube collar/holder, each |
31 |
24 |
$296.94 |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
13 |
12 |
$295.92 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
64 |
63 |
$233.84 |
| A7000 |
Canister, disposable, used with suction pump, each |
75 |
68 |
$220.26 |
| A7002 |
Tubing, used with suction pump, each |
109 |
87 |
$178.24 |
| B9002 |
Enteral nutrition infusion pump, any type |
15 |
15 |
$0.00 |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
678 |
653 |
$0.00 |