| 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 |
3,690 |
3,648 |
$265K |
| E0601 |
Continuous positive airway pressure (cpap) device |
3,267 |
3,259 |
$171K |
| E0570 |
Nebulizer, with compressor |
2,860 |
2,853 |
$131K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
3,101 |
3,092 |
$45K |
| A7030 |
Full face mask used with positive airway pressure device, each |
686 |
683 |
$41K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
3,226 |
3,216 |
$40K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
893 |
741 |
$36K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
190 |
188 |
$27K |
| 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 |
105 |
88 |
$18K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
606 |
603 |
$17K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,135 |
1,131 |
$16K |
| K0001 |
Standard wheelchair |
903 |
872 |
$16K |
| A7037 |
Tubing used with positive airway pressure device |
1,051 |
1,045 |
$15K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
514 |
512 |
$15K |
| A7035 |
Headgear used with positive airway pressure device |
872 |
862 |
$14K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
122 |
122 |
$14K |
| 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) |
128 |
128 |
$11K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
342 |
342 |
$10K |
| L3660 |
Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf |
164 |
164 |
$9K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
167 |
166 |
$9K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
72 |
69 |
$8K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
181 |
180 |
$7K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
71 |
70 |
$6K |
| A7031 |
Face mask interface, replacement for full face mask, each |
163 |
162 |
$5K |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
84 |
84 |
$5K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
102 |
98 |
$5K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
160 |
159 |
$4K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
273 |
273 |
$4K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
13 |
12 |
$2K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
75 |
74 |
$2K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
178 |
178 |
$1K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
152 |
145 |
$943.28 |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
37 |
37 |
$748.63 |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
14 |
14 |
$367.07 |
| E0156 |
Seat attachment, walker |
68 |
68 |
$304.88 |
| L3260 |
Surgical boot/shoe, each |
12 |
12 |
$239.61 |
| A7036 |
Chinstrap used with positive airway pressure device |
12 |
12 |
$112.75 |
| A4259 |
Lancets, per box of 100 |
29 |
29 |
$88.09 |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
12 |
12 |
$87.10 |
| A7015 |
Aerosol mask, used with dme nebulizer |
37 |
37 |
$45.21 |