| 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 |
2,159 |
1,900 |
$49K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
141 |
135 |
$24K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
83 |
69 |
$24K |
| 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 |
1,092 |
933 |
$20K |
| E0570 |
Nebulizer, with compressor |
1,658 |
1,562 |
$16K |
| E0601 |
Continuous positive airway pressure (cpap) device |
706 |
648 |
$16K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
200 |
194 |
$10K |
| 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 |
58 |
47 |
$8K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
546 |
515 |
$7K |
| A7030 |
Full face mask used with positive airway pressure device, each |
260 |
232 |
$7K |
| A7031 |
Face mask interface, replacement for full face mask, each |
392 |
311 |
$6K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
814 |
745 |
$4K |
| A7035 |
Headgear used with positive airway pressure device |
318 |
290 |
$4K |
| A7037 |
Tubing used with positive airway pressure device |
305 |
280 |
$3K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
181 |
163 |
$3K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
107 |
99 |
$2K |
| L3660 |
Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf |
18 |
18 |
$2K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
79 |
76 |
$2K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
224 |
206 |
$1K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
88 |
73 |
$1K |
| L3984 |
Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and adjustment |
12 |
12 |
$863.58 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
141 |
131 |
$655.58 |
| K0001 |
Standard wheelchair |
101 |
87 |
$441.22 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
54 |
44 |
$352.56 |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
33 |
27 |
$294.71 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
15 |
12 |
$175.78 |
| E0776 |
Iv pole |
13 |
12 |
$174.85 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
143 |
142 |
$89.86 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
50 |
46 |
$89.00 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
29 |
29 |
$55.64 |
| E0156 |
Seat attachment, walker |
16 |
13 |
$24.52 |