| 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 |
4,449 |
3,889 |
$348K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,800 |
1,676 |
$117K |
| A7030 |
Full face mask used with positive airway pressure device, each |
888 |
811 |
$85K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
941 |
845 |
$75K |
| E0570 |
Nebulizer, with compressor |
2,376 |
1,972 |
$73K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
2,054 |
1,828 |
$68K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,071 |
936 |
$64K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,783 |
1,392 |
$50K |
| K0001 |
Standard wheelchair |
2,980 |
2,363 |
$48K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
3,251 |
2,809 |
$44K |
| A7031 |
Face mask interface, replacement for full face mask, each |
994 |
898 |
$42K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
723 |
646 |
$39K |
| A7035 |
Headgear used with positive airway pressure device |
1,509 |
1,344 |
$30K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
542 |
485 |
$21K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
121 |
118 |
$21K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,961 |
2,636 |
$20K |
| A4927 |
Gloves, non-sterile, per 100 |
1,181 |
890 |
$17K |
| 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) |
115 |
107 |
$15K |
| T4541 |
Incontinence product, disposable underpad, large, each |
645 |
590 |
$13K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
830 |
722 |
$8K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
146 |
125 |
$7K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
304 |
275 |
$6K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
386 |
314 |
$6K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
53 |
50 |
$4K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
40 |
36 |
$2K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
26 |
25 |
$1K |
| A4670 |
Automatic blood pressure monitor |
32 |
25 |
$1K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
44 |
39 |
$459.54 |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
13 |
12 |
$196.93 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
79 |
70 |
$71.57 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
19 |
13 |
$0.00 |