| 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 |
13,848 |
12,693 |
$708K |
| A4927 |
Gloves, non-sterile, per 100 |
8,487 |
7,552 |
$300K |
| A7030 |
Full face mask used with positive airway pressure device, each |
3,166 |
3,030 |
$252K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,152 |
1,978 |
$251K |
| E0601 |
Continuous positive airway pressure (cpap) device |
6,969 |
6,451 |
$231K |
| T4541 |
Incontinence product, disposable underpad, large, each |
5,561 |
5,144 |
$190K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,553 |
1,401 |
$154K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
2,187 |
1,679 |
$151K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
4,387 |
4,199 |
$138K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
903 |
779 |
$129K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
2,246 |
2,143 |
$109K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
954 |
894 |
$105K |
| A7031 |
Face mask interface, replacement for full face mask, each |
3,512 |
3,279 |
$103K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
833 |
789 |
$98K |
| S5161 |
Emergency response system; service fee, per month (excludes installation and testing) |
1,712 |
1,514 |
$89K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
7,287 |
6,621 |
$79K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
818 |
426 |
$75K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
763 |
654 |
$65K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
788 |
668 |
$62K |
| E1392 |
Portable oxygen concentrator, rental |
3,406 |
3,100 |
$58K |
| A7035 |
Headgear used with positive airway pressure device |
3,484 |
3,324 |
$55K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,610 |
1,492 |
$42K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
1,025 |
722 |
$33K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
1,640 |
1,073 |
$29K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
6,595 |
6,161 |
$26K |
| E0570 |
Nebulizer, with compressor |
4,595 |
4,252 |
$24K |
| K0001 |
Standard wheelchair |
1,729 |
1,587 |
$23K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
367 |
333 |
$22K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
900 |
828 |
$20K |
| B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
34 |
24 |
$19K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,893 |
1,786 |
$18K |
| A4322 |
Irrigation syringe, bulb or piston, each |
515 |
462 |
$16K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
643 |
544 |
$14K |
| 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) |
161 |
156 |
$14K |
| E0434 |
Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing |
797 |
693 |
$11K |
| E1399 |
Durable medical equipment, miscellaneous |
52 |
27 |
$11K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
14 |
13 |
$10K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
93 |
75 |
$10K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
51 |
49 |
$10K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
40 |
36 |
$9K |
| B9002 |
Enteral nutrition infusion pump, any type |
130 |
116 |
$7K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
121 |
103 |
$7K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
972 |
869 |
$6K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
162 |
140 |
$5K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
949 |
907 |
$5K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
95 |
91 |
$3K |
| E0439 |
Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing |
76 |
62 |
$2K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
29 |
24 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,113 |
1,037 |
$2K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
45 |
40 |
$2K |
| A4402 |
Lubricant, per ounce |
314 |
256 |
$2K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
12 |
12 |
$2K |
| A7036 |
Chinstrap used with positive airway pressure device |
189 |
178 |
$1K |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
13 |
12 |
$1K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
185 |
158 |
$1K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
16 |
13 |
$974.08 |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
21 |
12 |
$667.22 |
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
14 |
12 |
$433.20 |
| E0776 |
Iv pole |
27 |
24 |
$365.65 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
71 |
48 |
$238.65 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
24 |
24 |
$221.53 |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
13 |
12 |
$51.36 |
| A7015 |
Aerosol mask, used with dme nebulizer |
14 |
13 |
$9.44 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
1,836 |
1,171 |
$0.00 |
| E0442 |
Stationary oxygen contents, liquid, 1 month's supply = 1 unit |
14 |
12 |
$0.00 |
| B9998 |
Noc for enteral supplies |
19 |
14 |
$0.00 |
| A9279 |
Monitoring feature/device, stand-alone or integrated, any type, includes all accessories, components and electronics, not otherwise classified |
94 |
94 |
$0.00 |