| 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 |
20,462 |
18,446 |
$1.99M |
| E0601 |
Continuous positive airway pressure (cpap) device |
15,382 |
14,595 |
$851K |
| A7030 |
Full face mask used with positive airway pressure device, each |
5,179 |
4,904 |
$504K |
| E0570 |
Nebulizer, with compressor |
10,931 |
10,458 |
$368K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,502 |
1,433 |
$340K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
17,017 |
16,087 |
$328K |
| 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) |
2,012 |
1,869 |
$248K |
| 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 |
363 |
339 |
$204K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
5,785 |
5,511 |
$187K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
1,709 |
1,650 |
$172K |
| T4541 |
Incontinence product, disposable underpad, large, each |
3,299 |
3,080 |
$168K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
4,127 |
3,830 |
$166K |
| E1392 |
Portable oxygen concentrator, rental |
6,849 |
5,968 |
$159K |
| A4670 |
Automatic blood pressure monitor |
2,543 |
2,483 |
$158K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
2,288 |
2,173 |
$153K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
1,506 |
1,477 |
$152K |
| K0001 |
Standard wheelchair |
5,647 |
5,173 |
$150K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
974 |
935 |
$147K |
| 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 |
876 |
755 |
$145K |
| 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 |
5,312 |
4,867 |
$139K |
| A7035 |
Headgear used with positive airway pressure device |
5,816 |
5,530 |
$134K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,032 |
969 |
$126K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,101 |
1,053 |
$125K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
545 |
544 |
$119K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,749 |
1,679 |
$97K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,022 |
921 |
$88K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
2,630 |
2,576 |
$84K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
1,408 |
1,365 |
$79K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
4,034 |
3,704 |
$77K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
3,792 |
3,646 |
$73K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
1,859 |
1,663 |
$66K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
1,931 |
1,885 |
$66K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
2,365 |
2,271 |
$63K |
| 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 |
545 |
514 |
$61K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,312 |
1,245 |
$58K |
| K0006 |
Heavy duty wheelchair |
1,034 |
985 |
$55K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
1,819 |
1,588 |
$54K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,645 |
1,547 |
$51K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
866 |
816 |
$50K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
1,153 |
1,106 |
$49K |
| 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 |
497 |
470 |
$46K |
| A7526 |
Tracheostomy tube collar/holder, each |
799 |
742 |
$45K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
997 |
936 |
$43K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
2,657 |
2,535 |
$33K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
4,835 |
4,622 |
$31K |
| A4927 |
Gloves, non-sterile, per 100 |
2,282 |
2,130 |
$30K |
| L1812 |
Knee orthosis, elastic with joints, prefabricated, off-the-shelf |
959 |
893 |
$29K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
522 |
471 |
$27K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,413 |
2,199 |
$25K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
162 |
152 |
$24K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
1,304 |
1,288 |
$20K |
| A4452 |
Tape, waterproof, per 18 square inches |
887 |
796 |
$18K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
1,767 |
1,579 |
$18K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
705 |
644 |
$16K |
| L3650 |
Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf |
481 |
478 |
$16K |
| 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 |
137 |
127 |
$15K |
| 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) |
53 |
49 |
$15K |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
446 |
410 |
$14K |
| E0245 |
Tub stool or bench |
357 |
334 |
$13K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
289 |
269 |
$12K |
| E0156 |
Seat attachment, walker |
938 |
895 |
$11K |
| A7000 |
Canister, disposable, used with suction pump, each |
953 |
904 |
$11K |
| K0003 |
Lightweight wheelchair |
185 |
155 |
$10K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
133 |
115 |
$9K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
74 |
68 |
$8K |
| L3670 |
Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf |
335 |
324 |
$8K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
72 |
62 |
$8K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
57 |
49 |
$8K |
| A4388 |
Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each |
227 |
215 |
$8K |
| E0776 |
Iv pole |
1,143 |
988 |
$7K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
447 |
420 |
$7K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,842 |
1,739 |
$6K |
| 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 |
74 |
64 |
$5K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
785 |
709 |
$5K |
| A7002 |
Tubing, used with suction pump, each |
1,062 |
1,020 |
$5K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
41 |
41 |
$5K |
| A4649 |
Surgical supply; miscellaneous |
104 |
97 |
$5K |
| K0007 |
Extra heavy duty wheelchair |
73 |
73 |
$5K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,244 |
1,120 |
$4K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
43 |
38 |
$4K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
162 |
125 |
$3K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
30 |
28 |
$3K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
76 |
66 |
$3K |
| E0303 |
Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress |
37 |
37 |
$3K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
39 |
38 |
$3K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
104 |
102 |
$3K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
905 |
887 |
$3K |
| B4100 |
Food thickener, administered orally, per ounce |
15 |
12 |
$2K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
25 |
24 |
$2K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
586 |
557 |
$2K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
16 |
12 |
$2K |
| A5120 |
Skin barrier, wipes or swabs, each |
243 |
219 |
$2K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
14 |
13 |
$1K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
12 |
12 |
$1K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
17 |
16 |
$1K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
68 |
54 |
$1K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
30 |
25 |
$1K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
38 |
37 |
$1K |
| E0135 |
Walker, folding (pickup), adjustable or fixed height |
16 |
15 |
$1K |
| A7015 |
Aerosol mask, used with dme nebulizer |
710 |
679 |
$921.69 |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
14 |
12 |
$812.85 |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
217 |
195 |
$587.05 |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
24 |
24 |
$390.61 |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
14 |
12 |
$362.46 |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
13 |
12 |
$354.06 |
| A4322 |
Irrigation syringe, bulb or piston, each |
29 |
26 |
$347.81 |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
13 |
12 |
$331.38 |
| A7037 |
Tubing used with positive airway pressure device |
13 |
13 |
$262.60 |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
37 |
37 |
$254.78 |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
27 |
26 |
$65.27 |
| A4371 |
Ostomy skin barrier, powder, per oz |
14 |
12 |
$48.07 |