| 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 |
2,884 |
2,806 |
$263K |
| E0439 |
Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing |
1,609 |
1,477 |
$124K |
| E0570 |
Nebulizer, with compressor |
2,549 |
2,464 |
$121K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,566 |
1,530 |
$111K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,293 |
1,276 |
$94K |
| A7030 |
Full face mask used with positive airway pressure device, each |
858 |
855 |
$92K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,129 |
1,121 |
$87K |
| A7031 |
Face mask interface, replacement for full face mask, each |
989 |
978 |
$70K |
| A7035 |
Headgear used with positive airway pressure device |
1,972 |
1,959 |
$53K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,182 |
3,093 |
$48K |
| A7037 |
Tubing used with positive airway pressure device |
1,290 |
1,283 |
$30K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
772 |
738 |
$25K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
552 |
550 |
$24K |
| E0434 |
Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing |
1,600 |
1,454 |
$19K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
111 |
110 |
$19K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
99 |
98 |
$15K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
362 |
323 |
$15K |
| T4541 |
Incontinence product, disposable underpad, large, each |
416 |
411 |
$15K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
928 |
904 |
$15K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
1,079 |
1,077 |
$13K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
587 |
579 |
$13K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
822 |
817 |
$10K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
826 |
812 |
$10K |
| K0001 |
Standard wheelchair |
465 |
444 |
$10K |
| L4360 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
50 |
49 |
$8K |
| A4927 |
Gloves, non-sterile, per 100 |
363 |
347 |
$5K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
158 |
156 |
$5K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
27 |
26 |
$5K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
192 |
188 |
$4K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
569 |
553 |
$2K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
63 |
63 |
$2K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
263 |
240 |
$1K |
| A7015 |
Aerosol mask, used with dme nebulizer |
844 |
826 |
$1K |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
639 |
621 |
$336.30 |