| Code | Description | Claims | Beneficiaries | Total Paid |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
5,368 |
2,010 |
$491K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
1,101 |
999 |
$185K |
| E0601 |
Continuous positive airway pressure (cpap) device |
3,598 |
3,346 |
$177K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
3,374 |
2,028 |
$174K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
2,932 |
2,333 |
$140K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
3,151 |
2,931 |
$137K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,032 |
1,845 |
$110K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
1,783 |
1,586 |
$59K |
| 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) |
367 |
344 |
$39K |
| A7035 |
Headgear used with positive airway pressure device |
1,953 |
1,761 |
$30K |
| K0001 |
Standard wheelchair |
1,092 |
1,025 |
$26K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,672 |
1,486 |
$26K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
276 |
239 |
$25K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,736 |
1,592 |
$22K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,217 |
1,063 |
$22K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
267 |
169 |
$18K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
243 |
225 |
$11K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
407 |
351 |
$10K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
82 |
79 |
$9K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,474 |
3,036 |
$8K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
367 |
291 |
$7K |
| A7037 |
Tubing used with positive airway pressure device |
460 |
413 |
$7K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
283 |
234 |
$5K |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
104 |
74 |
$5K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
130 |
91 |
$4K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
92 |
88 |
$4K |
| K0040 |
Adjustable angle footplate, each |
53 |
42 |
$3K |
| K0070 |
Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each |
26 |
26 |
$2K |
| E0570 |
Nebulizer, with compressor |
106 |
90 |
$1K |
| E2213 |
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
29 |
25 |
$982.21 |
| E0950 |
Wheelchair accessory, tray, each |
15 |
13 |
$829.72 |
| E2211 |
Manual wheelchair accessory, pneumatic propulsion tire, any size, each |
19 |
15 |
$707.10 |
| A4927 |
Gloves, non-sterile, per 100 |
44 |
43 |
$590.92 |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
12 |
12 |
$569.91 |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
16 |
14 |
$378.51 |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
19 |
12 |
$300.70 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
70 |
61 |
$154.53 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
13 |
13 |
$100.89 |