| 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 |
3,859 |
3,757 |
$297K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,172 |
1,155 |
$130K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,853 |
1,810 |
$101K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
2,279 |
2,247 |
$99K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,656 |
1,535 |
$86K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,668 |
1,653 |
$74K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
620 |
546 |
$70K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
983 |
965 |
$70K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
616 |
576 |
$54K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
639 |
600 |
$52K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
322 |
302 |
$41K |
| A7035 |
Headgear used with positive airway pressure device |
1,680 |
1,656 |
$38K |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
357 |
340 |
$22K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,469 |
1,439 |
$19K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,442 |
3,389 |
$19K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
188 |
167 |
$18K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
831 |
821 |
$12K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
239 |
228 |
$9K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
241 |
237 |
$9K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
37 |
36 |
$3K |
| E1392 |
Portable oxygen concentrator, rental |
78 |
77 |
$3K |
| 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 |
63 |
62 |
$3K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
77 |
72 |
$2K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
26 |
12 |
$2K |
| A4452 |
Tape, waterproof, per 18 square inches |
39 |
39 |
$951.58 |
| A6240 |
Hydrocolloid dressing, wound filler, paste, sterile, per ounce |
13 |
13 |
$752.10 |
| K0001 |
Standard wheelchair |
34 |
34 |
$687.99 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
73 |
69 |
$424.46 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
133 |
114 |
$414.84 |
| A7037 |
Tubing used with positive airway pressure device |
26 |
25 |
$0.00 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
13 |
13 |
$0.00 |