| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
8,933 |
7,112 |
$315K |
| B4035 |
Enteral feed supp pump per d |
1,755 |
1,010 |
$159K |
| B4161 |
Ef ped hydrolyzed/amino acid |
415 |
286 |
$147K |
| E0431 |
Portable gaseous 02 |
8,258 |
6,620 |
$109K |
| K0108 |
W/c component-accessory nos |
445 |
243 |
$92K |
| K0001 |
Standard wheelchair |
8,004 |
6,791 |
$85K |
| E1007 |
Pwr seat combo w/shear |
19 |
12 |
$77K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
522 |
384 |
$69K |
| E1028 |
W/c manual swingaway |
595 |
361 |
$62K |
| E0445 |
Oximeter non-invasive |
632 |
562 |
$50K |
| B9998 |
Enteral supp not otherwise c |
871 |
519 |
$50K |
| B4152 |
Ef calorie dense>/=1.5kcal |
890 |
667 |
$43K |
| L4361 |
Pneuma/vac walk boot pre ots |
263 |
245 |
$42K |
| E1161 |
Manual adult wc w tiltinspac |
378 |
207 |
$40K |
| K0195 |
Elevating whlchair leg rests |
5,189 |
4,387 |
$40K |
| B9002 |
Enter nutr inf pump any type |
648 |
504 |
$36K |
| K0739 |
Repair/svc dme non-oxygen eq |
615 |
469 |
$32K |
| E0143 |
Walker folding wheeled w/o s |
1,655 |
1,294 |
$31K |
| E1009 |
Add mech leg elevation |
23 |
14 |
$29K |
| E0630 |
Patient lift hydraulic |
1,556 |
1,245 |
$28K |
| S8120 |
O2 contents gas cubic ft |
1,445 |
687 |
$27K |
| E2311 |
Electro connect btw 2 sys |
23 |
14 |
$25K |
| E0971 |
Wheelchair anti-tipping devi |
6,650 |
3,038 |
$24K |
| E0261 |
Hosp bed semi-electr w/o mat |
1,347 |
1,217 |
$23K |
| E0955 |
Cushioned headrest |
495 |
391 |
$21K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
1,199 |
1,074 |
$21K |
| B4034 |
Enter feed supkit syr by day |
633 |
453 |
$21K |
| E0260 |
Hosp bed semi-electr w/ matt |
922 |
804 |
$20K |
| K0006 |
Heavy duty wheelchair |
695 |
592 |
$20K |
| A7030 |
Cpap full face mask |
360 |
317 |
$18K |
| E0443 |
Portable 02 contents, gas |
738 |
501 |
$17K |
| E0250 |
Hosp bed fixed ht w/ mattres |
1,263 |
933 |
$16K |
| E0601 |
Cont airway pressure device |
506 |
486 |
$16K |
| E2601 |
Gen w/c cushion wdth < 22 in |
854 |
676 |
$15K |
| B4088 |
Gastro/jejuno tube, low-pro |
271 |
208 |
$14K |
| E0600 |
Suction pump portab hom modl |
587 |
483 |
$14K |
| K0823 |
Pwc gp 2 std cap chair |
89 |
77 |
$13K |
| K0007 |
Extra heavy duty wheelchair |
364 |
314 |
$13K |
| A7035 |
Pos airway press headgear |
624 |
551 |
$13K |
| A7526 |
Tracheostomy tube collar |
230 |
177 |
$12K |
| A4604 |
Tubing with heating element |
504 |
456 |
$12K |
| E2620 |
Wc planar back cush wd <22in |
34 |
18 |
$10K |
| A4624 |
Tracheal suction tube |
46 |
42 |
$10K |
| E1226 |
Manual fully reclining back |
349 |
292 |
$9K |
| E0570 |
Nebulizer with compression |
1,702 |
1,581 |
$8K |
| L3908 |
Who cock-up nonmolde pre ots |
222 |
202 |
$8K |
| A4213 |
20+ cc syringe only |
686 |
520 |
$8K |
| B4150 |
Ef complet w/intact nutrient |
53 |
39 |
$8K |
| E0251 |
Hosp bed fixd ht w/o mattres |
930 |
669 |
$8K |
| A7034 |
Nasal application device |
244 |
219 |
$7K |
| E0163 |
Commode chair with fixed arm |
404 |
315 |
$7K |
| E0562 |
Humidifier heated used w pap |
669 |
621 |
$7K |
| E2361 |
22nf sealed leadacid battery |
55 |
33 |
$7K |
| A7031 |
Replacement facemask interfa |
297 |
255 |
$7K |
| E0114 |
Crutch underarm pair no wood |
172 |
161 |
$5K |
| E0973 |
W/ch access det adj armrest |
116 |
62 |
$5K |
| E0951 |
Loop heel |
1,050 |
494 |
$5K |
| K0040 |
Adjustable angle footplate |
65 |
37 |
$5K |
| E2611 |
Gen use back cush wdth <22in |
32 |
28 |
$5K |
| E2377 |
Expandable controller, initl |
19 |
12 |
$4K |
| E0165 |
Commode chair with detacharm |
550 |
476 |
$4K |
| K0003 |
Lightweight wheelchair |
242 |
202 |
$4K |
| E2607 |
Skin pro/pos wc cus wd <22in |
27 |
14 |
$4K |
| B4155 |
Ef incomplete/modular |
154 |
117 |
$3K |
| A7507 |
Integrated filter & holder |
74 |
53 |
$3K |
| E0184 |
Dry pressure mattress |
95 |
74 |
$3K |
| A4657 |
Syringe w/wo needle |
472 |
313 |
$3K |
| L1902 |
Afo ankle gauntlet pre ots |
57 |
52 |
$3K |
| A7038 |
Pos airway pressure filter |
1,057 |
896 |
$3K |
| A7032 |
Replacement nasal cushion |
232 |
194 |
$3K |
| E0978 |
W/c acc,saf belt pelv strap |
240 |
182 |
$3K |
| A4927 |
Non-sterile gloves |
214 |
161 |
$2K |
| A7000 |
Disposable canister for pump |
231 |
146 |
$2K |
| A7002 |
Tubing used w suction pump |
237 |
158 |
$2K |
| A4629 |
Tracheostomy care kit |
19 |
14 |
$2K |
| K0002 |
Stnd hemi (low seat) whlchr |
108 |
85 |
$1K |
| A7046 |
Repl water chamber, pap dev |
168 |
159 |
$1K |
| E0961 |
Wheelchair brake extension |
240 |
119 |
$992.70 |
| A4628 |
Oropharyngeal suction cath |
72 |
63 |
$978.42 |
| A7003 |
Nebulizer administration set |
492 |
309 |
$941.18 |
| A6402 |
Sterile gauze <= 16 sq in |
125 |
78 |
$808.42 |
| E0277 |
Powered pres-redu air mattrs |
16 |
12 |
$776.55 |
| A7039 |
Filter, non disposable w pap |
184 |
134 |
$657.56 |
| E2208 |
Cylinder tank carrier |
31 |
26 |
$535.08 |
| L1830 |
Ko immob canvas long pre ots |
13 |
13 |
$523.73 |
| E0149 |
Heavy duty wheeled walker |
66 |
61 |
$398.93 |
| E2202 |
Seat width 24-27 in |
26 |
24 |
$337.36 |
| E0266 |
Hosp bed total elec w/o matt |
14 |
12 |
$291.69 |
| A7525 |
Tracheostomy mask |
37 |
25 |
$171.65 |
| E1392 |
Portable oxygen concentrator |
12 |
12 |
$153.91 |
| A7037 |
Pos airway pressure tubing |
14 |
12 |
$149.88 |
| A4615 |
Cannula nasal |
127 |
75 |
$115.03 |
| E1038 |
Transport chair pt wt<=300lb |
25 |
25 |
$73.00 |