| 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 |
20,102 |
11,549 |
$468K |
| 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 |
2,750 |
1,853 |
$208K |
| K0001 |
Standard wheelchair |
12,729 |
8,430 |
$150K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
8,684 |
4,567 |
$92K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
545 |
511 |
$67K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,117 |
1,347 |
$63K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
3,019 |
1,937 |
$60K |
| 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 |
971 |
576 |
$46K |
| E0570 |
Nebulizer, with compressor |
9,753 |
5,990 |
$37K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
17,961 |
10,374 |
$36K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
2,485 |
1,544 |
$27K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,906 |
1,731 |
$25K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
7,865 |
5,178 |
$16K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
347 |
248 |
$16K |
| E0601 |
Continuous positive airway pressure (cpap) device |
839 |
529 |
$16K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
2,403 |
1,253 |
$15K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
1,623 |
1,221 |
$14K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
3,894 |
2,386 |
$11K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
267 |
166 |
$11K |
| A4554 |
Disposable underpads, all sizes |
279 |
268 |
$10K |
| K0003 |
Lightweight wheelchair |
1,191 |
703 |
$8K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,266 |
2,538 |
$6K |
| 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) |
250 |
140 |
$6K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
1,008 |
625 |
$6K |
| A4927 |
Gloves, non-sterile, per 100 |
545 |
438 |
$6K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
328 |
217 |
$5K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
534 |
502 |
$4K |
| A4456 |
Adhesive remover, wipes, any type, each |
357 |
313 |
$4K |
| E1392 |
Portable oxygen concentrator, rental |
1,393 |
743 |
$2K |
| K0006 |
Heavy duty wheelchair |
132 |
87 |
$1K |
| A7000 |
Canister, disposable, used with suction pump, each |
830 |
545 |
$1K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
1,842 |
962 |
$1K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
588 |
422 |
$1K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
397 |
240 |
$1K |
| B9002 |
Enteral nutrition infusion pump, any type |
125 |
81 |
$1K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
153 |
115 |
$1K |
| E0776 |
Iv pole |
232 |
155 |
$1K |
| E0156 |
Seat attachment, walker |
505 |
297 |
$612.47 |
| A7526 |
Tracheostomy tube collar/holder, each |
274 |
192 |
$569.25 |
| A7002 |
Tubing, used with suction pump, each |
856 |
558 |
$474.62 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
62 |
40 |
$276.00 |
| A7015 |
Aerosol mask, used with dme nebulizer |
865 |
623 |
$249.68 |
| A7030 |
Full face mask used with positive airway pressure device, each |
28 |
16 |
$218.03 |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
25 |
16 |
$161.44 |
| A7035 |
Headgear used with positive airway pressure device |
80 |
49 |
$44.70 |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
46 |
26 |
$32.24 |
| A7037 |
Tubing used with positive airway pressure device |
101 |
62 |
$1.91 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
26 |
15 |
$1.44 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
48 |
31 |
$0.00 |