| 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 |
4,574 |
4,107 |
$109K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,825 |
1,625 |
$53K |
| K0003 |
Lightweight wheelchair |
1,636 |
1,402 |
$48K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
919 |
765 |
$39K |
| E0570 |
Nebulizer, with compressor |
2,008 |
1,819 |
$20K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,676 |
1,520 |
$14K |
| K0001 |
Standard wheelchair |
563 |
512 |
$13K |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
1,501 |
1,324 |
$12K |
| A7035 |
Headgear used with positive airway pressure device |
426 |
386 |
$6K |
| A7030 |
Full face mask used with positive airway pressure device, each |
157 |
143 |
$6K |
| A7037 |
Tubing used with positive airway pressure device |
582 |
535 |
$6K |
| L8000 |
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
329 |
207 |
$6K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
235 |
196 |
$5K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
117 |
101 |
$4K |
| T4541 |
Incontinence product, disposable underpad, large, each |
116 |
106 |
$4K |
| L8020 |
Breast prosthesis, mastectomy form |
108 |
63 |
$4K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
90 |
82 |
$4K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,107 |
961 |
$3K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
17 |
16 |
$2K |
| A4927 |
Gloves, non-sterile, per 100 |
128 |
115 |
$2K |
| A7031 |
Face mask interface, replacement for full face mask, each |
82 |
69 |
$2K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
250 |
222 |
$2K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
17 |
16 |
$1K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
575 |
452 |
$1K |
| E1392 |
Portable oxygen concentrator, rental |
70 |
67 |
$873.78 |
| 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 |
127 |
122 |
$763.97 |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
14 |
14 |
$555.78 |
| K0007 |
Extra heavy duty wheelchair |
46 |
36 |
$554.54 |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
39 |
25 |
$438.61 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
12 |
12 |
$199.89 |
| A7015 |
Aerosol mask, used with dme nebulizer |
12 |
12 |
$29.88 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
17 |
12 |
$6.58 |