| 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 |
2,726 |
2,715 |
$320K |
| T4541 |
Incontinence product, disposable underpad, large, each |
3,795 |
3,653 |
$141K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,418 |
2,289 |
$134K |
| K0001 |
Standard wheelchair |
4,755 |
4,726 |
$124K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,252 |
1,252 |
$116K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,966 |
1,934 |
$95K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
1,840 |
1,818 |
$93K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,941 |
1,876 |
$89K |
| E0295 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress |
1,011 |
1,010 |
$74K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,129 |
1,104 |
$71K |
| 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) |
100 |
100 |
$47K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
774 |
774 |
$46K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,274 |
2,257 |
$46K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
884 |
884 |
$44K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,473 |
1,468 |
$39K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
4,255 |
4,233 |
$29K |
| A7035 |
Headgear used with positive airway pressure device |
1,511 |
1,510 |
$29K |
| A7037 |
Tubing used with positive airway pressure device |
1,536 |
1,536 |
$27K |
| K0006 |
Heavy duty wheelchair |
305 |
298 |
$22K |
| E0570 |
Nebulizer, with compressor |
805 |
804 |
$16K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,013 |
1,009 |
$14K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
245 |
245 |
$13K |
| E1399 |
Durable medical equipment, miscellaneous |
218 |
138 |
$12K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
222 |
220 |
$12K |
| E0305 |
Bed side rails, half length |
800 |
796 |
$10K |
| A7030 |
Full face mask used with positive airway pressure device, each |
146 |
146 |
$10K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
1,274 |
1,274 |
$9K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
484 |
477 |
$8K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
1,069 |
803 |
$8K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
321 |
287 |
$8K |
| E0272 |
Mattress, foam rubber |
557 |
545 |
$7K |
| K0003 |
Lightweight wheelchair |
148 |
148 |
$6K |
| E0265 |
Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress |
25 |
25 |
$4K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
250 |
250 |
$3K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
133 |
133 |
$3K |
| A7031 |
Face mask interface, replacement for full face mask, each |
109 |
85 |
$3K |
| A6549 |
Gradient compression garment, not otherwise specified, for daytime use, each |
56 |
36 |
$3K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
41 |
36 |
$2K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
63 |
42 |
$2K |
| E0627 |
Seat lift mechanism, electric, any type |
120 |
114 |
$2K |
| E0245 |
Tub stool or bench |
39 |
39 |
$2K |
| E1392 |
Portable oxygen concentrator, rental |
12 |
12 |
$2K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
38 |
38 |
$1K |
| K0007 |
Extra heavy duty wheelchair |
68 |
68 |
$1K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
49 |
49 |
$837.84 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
186 |
186 |
$812.58 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
74 |
74 |
$729.31 |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
321 |
191 |
$501.71 |
| E0156 |
Seat attachment, walker |
37 |
36 |
$436.18 |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
58 |
53 |
$314.83 |
| A4402 |
Lubricant, per ounce |
12 |
12 |
$12.70 |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
114 |
99 |
$0.00 |
| E2208 |
Wheelchair accessory, cylinder tank carrier, each |
95 |
94 |
$0.00 |