| 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 |
6,319 |
5,639 |
$472K |
| E0601 |
Continuous positive airway pressure (cpap) device |
6,051 |
5,745 |
$288K |
| K0001 |
Standard wheelchair |
7,616 |
6,815 |
$191K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,421 |
1,345 |
$127K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
3,072 |
2,652 |
$126K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
2,779 |
2,605 |
$119K |
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 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 |
618 |
580 |
$104K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
3,419 |
3,220 |
$94K |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
1,126 |
1,057 |
$88K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
359 |
330 |
$88K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,629 |
1,524 |
$85K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
776 |
669 |
$76K |
| 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 |
2,646 |
2,408 |
$71K |
| L3670 |
Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf |
670 |
613 |
$56K |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
733 |
677 |
$50K |
| A7035 |
Headgear used with positive airway pressure device |
2,102 |
1,962 |
$49K |
| E0570 |
Nebulizer, with compressor |
1,286 |
1,106 |
$44K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
273 |
261 |
$43K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,600 |
3,359 |
$42K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
623 |
568 |
$36K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,024 |
1,745 |
$35K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
3,616 |
3,320 |
$35K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
386 |
308 |
$33K |
| T4541 |
Incontinence product, disposable underpad, large, each |
835 |
666 |
$32K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
400 |
357 |
$21K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,252 |
1,177 |
$18K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
181 |
140 |
$14K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
228 |
207 |
$11K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
503 |
476 |
$11K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
217 |
203 |
$9K |
| L3807 |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
37 |
32 |
$7K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
642 |
593 |
$6K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
201 |
196 |
$6K |
| 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 |
53 |
52 |
$5K |
| E0245 |
Tub stool or bench |
119 |
105 |
$4K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
1,078 |
958 |
$4K |
| L3660 |
Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf |
64 |
63 |
$4K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
57 |
50 |
$4K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
51 |
48 |
$3K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
30 |
25 |
$2K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
201 |
194 |
$2K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
181 |
154 |
$2K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
27 |
26 |
$2K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
457 |
418 |
$1K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
63 |
57 |
$636.55 |
| E0156 |
Seat attachment, walker |
29 |
26 |
$349.63 |
| L3260 |
Surgical boot/shoe, each |
13 |
13 |
$120.40 |