| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0603 |
Breast pump, electric (ac and/or dc), any type |
6,525 |
6,019 |
$600K |
| L2630 |
Addition to lower extremity, pelvic control, band and belt, unilateral |
2,587 |
2,420 |
$442K |
| K1005 |
Disposable collection and storage bag for breast milk, any size, any type, each |
13,144 |
13,045 |
$440K |
| A4287 |
Disposable collection and storage bag for breast milk, any size, any type, each |
12,976 |
12,885 |
$419K |
| E0601 |
Continuous positive airway pressure (cpap) device |
7,151 |
6,629 |
$287K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
4,401 |
3,818 |
$287K |
| A7030 |
Full face mask used with positive airway pressure device, each |
3,072 |
2,848 |
$231K |
| L0621 |
Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf |
2,864 |
2,706 |
$158K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
2,575 |
2,452 |
$142K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,129 |
1,002 |
$116K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
4,613 |
4,239 |
$115K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
2,205 |
2,021 |
$106K |
| A7031 |
Face mask interface, replacement for full face mask, each |
2,234 |
2,080 |
$74K |
| A7035 |
Headgear used with positive airway pressure device |
3,851 |
3,556 |
$73K |
| 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) |
756 |
635 |
$60K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,343 |
1,243 |
$59K |
| E1392 |
Portable oxygen concentrator, rental |
2,107 |
1,704 |
$33K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
6,246 |
5,796 |
$32K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
2,766 |
2,608 |
$27K |
| E0570 |
Nebulizer, with compressor |
455 |
430 |
$23K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
2,514 |
2,274 |
$17K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
819 |
798 |
$10K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
223 |
216 |
$8K |
| L0625 |
Lumbar orthosis, flexible, provides lumbar support, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include pendulous abdomen design, shoulder straps, stays, prefabricated, off-the-shelf |
118 |
115 |
$4K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
81 |
78 |
$4K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
194 |
177 |
$3K |
| E0602 |
Breast pump, manual, any type |
144 |
135 |
$2K |
| A7037 |
Tubing used with positive airway pressure device |
125 |
121 |
$2K |
| A4670 |
Automatic blood pressure monitor |
25 |
25 |
$1K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
14 |
14 |
$1K |
| T4541 |
Incontinence product, disposable underpad, large, each |
13 |
12 |
$534.56 |
| A4927 |
Gloves, non-sterile, per 100 |
15 |
15 |
$156.39 |