| 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 |
2,834 |
2,582 |
$238K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,716 |
1,519 |
$103K |
| A7030 |
Full face mask used with positive airway pressure device, each |
885 |
789 |
$88K |
| A7031 |
Face mask interface, replacement for full face mask, each |
2,311 |
2,091 |
$85K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,657 |
1,527 |
$69K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
822 |
695 |
$67K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
407 |
365 |
$58K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
908 |
854 |
$43K |
| A4927 |
Gloves, non-sterile, per 100 |
1,749 |
1,469 |
$34K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
237 |
193 |
$34K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
384 |
351 |
$26K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
614 |
353 |
$24K |
| A7035 |
Headgear used with positive airway pressure device |
930 |
846 |
$21K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,693 |
3,411 |
$20K |
| A4206 |
Syringe with needle, sterile, 1 cc or less, each |
406 |
376 |
$16K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
941 |
867 |
$15K |
| T4541 |
Incontinence product, disposable underpad, large, each |
762 |
663 |
$15K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,349 |
1,252 |
$14K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
118 |
111 |
$10K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
91 |
79 |
$8K |
| E0570 |
Nebulizer, with compressor |
351 |
340 |
$7K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
145 |
133 |
$7K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
505 |
463 |
$6K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
28 |
25 |
$3K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
12 |
12 |
$3K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
56 |
49 |
$2K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
25 |
25 |
$1K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
55 |
42 |
$825.90 |
| A4259 |
Lancets, per box of 100 |
14 |
14 |
$15.62 |