| 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 |
8,099 |
6,177 |
$215K |
| E0570 |
Nebulizer, with compressor |
2,730 |
2,089 |
$79K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,335 |
1,847 |
$59K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
6,731 |
5,133 |
$42K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,421 |
1,140 |
$30K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
2,339 |
1,847 |
$19K |
| K0001 |
Standard wheelchair |
2,009 |
1,621 |
$17K |
| A7030 |
Full face mask used with positive airway pressure device, each |
347 |
271 |
$13K |
| A7035 |
Headgear used with positive airway pressure device |
1,143 |
929 |
$11K |
| A7037 |
Tubing used with positive airway pressure device |
1,373 |
1,109 |
$9K |
| A7031 |
Face mask interface, replacement for full face mask, each |
382 |
307 |
$7K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,794 |
2,297 |
$6K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
871 |
692 |
$6K |
| K0006 |
Heavy duty wheelchair |
189 |
138 |
$4K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
133 |
115 |
$4K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
159 |
137 |
$3K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
88 |
38 |
$3K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
864 |
701 |
$3K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
87 |
38 |
$3K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
988 |
809 |
$2K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
157 |
125 |
$1K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
92 |
66 |
$341.27 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
18 |
13 |
$202.35 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
17 |
12 |
$29.10 |
| A4259 |
Lancets, per box of 100 |
118 |
92 |
$24.90 |