| 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 |
3,291 |
2,705 |
$267K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
1,422 |
1,290 |
$153K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,313 |
1,149 |
$68K |
| E1392 |
Portable oxygen concentrator, rental |
1,344 |
1,192 |
$34K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
715 |
569 |
$33K |
| E0570 |
Nebulizer, with compressor |
1,096 |
1,001 |
$24K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
197 |
177 |
$22K |
| A7030 |
Full face mask used with positive airway pressure device, each |
233 |
219 |
$20K |
| A7035 |
Headgear used with positive airway pressure device |
379 |
361 |
$18K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
699 |
612 |
$18K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
249 |
235 |
$13K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
543 |
498 |
$12K |
| A4554 |
Disposable underpads, all sizes |
418 |
379 |
$11K |
| K0001 |
Standard wheelchair |
626 |
565 |
$11K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
123 |
113 |
$9K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
60 |
54 |
$7K |
| A7037 |
Tubing used with positive airway pressure device |
175 |
158 |
$6K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
111 |
107 |
$3K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
37 |
37 |
$3K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
47 |
40 |
$878.79 |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
19 |
12 |
$337.78 |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
12 |
12 |
$277.35 |