| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0603 |
Breast pump, electric (ac and/or dc), any type |
3,661 |
3,657 |
$553K |
| E0601 |
Continuous positive airway pressure (cpap) device |
4,572 |
4,505 |
$277K |
| A4554 |
Disposable underpads, all sizes |
2,042 |
2,029 |
$146K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
971 |
959 |
$93K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
2,106 |
2,076 |
$87K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
925 |
922 |
$81K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
581 |
579 |
$69K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
932 |
926 |
$50K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,390 |
1,389 |
$36K |
| A7030 |
Full face mask used with positive airway pressure device, each |
583 |
582 |
$31K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
132 |
131 |
$19K |
| A7035 |
Headgear used with positive airway pressure device |
1,654 |
1,651 |
$16K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
124 |
120 |
$16K |
| A7037 |
Tubing used with positive airway pressure device |
1,261 |
1,259 |
$11K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,035 |
3,031 |
$10K |
| L0621 |
Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf |
161 |
161 |
$9K |
| A4670 |
Automatic blood pressure monitor |
197 |
197 |
$9K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
287 |
287 |
$7K |
| A7031 |
Face mask interface, replacement for full face mask, each |
273 |
271 |
$6K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
180 |
179 |
$6K |
| K0001 |
Standard wheelchair |
455 |
452 |
$6K |
| A4927 |
Gloves, non-sterile, per 100 |
1,218 |
1,208 |
$5K |
| E0570 |
Nebulizer, with compressor |
104 |
103 |
$5K |
| 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) |
77 |
75 |
$4K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
238 |
234 |
$4K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
124 |
124 |
$4K |
| E2103 |
Non-adjunctive, non-implanted continuous glucose monitor or receiver |
28 |
27 |
$2K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
412 |
411 |
$2K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
52 |
52 |
$1K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
41 |
40 |
$745.61 |
| E0241 |
Bath tub wall rail, each |
12 |
12 |
$410.24 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
133 |
133 |
$337.53 |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
12 |
12 |
$235.57 |
| A7015 |
Aerosol mask, used with dme nebulizer |
198 |
198 |
$210.75 |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
12 |
12 |
$126.49 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
142 |
140 |
$119.49 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
57 |
54 |
$111.43 |