| 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 |
404 |
356 |
$36K |
| E0601 |
Continuous positive airway pressure (cpap) device |
259 |
215 |
$24K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
142 |
131 |
$22K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
221 |
196 |
$14K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
165 |
149 |
$12K |
| E0570 |
Nebulizer, with compressor |
383 |
343 |
$10K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
137 |
131 |
$10K |
| A4927 |
Gloves, non-sterile, per 100 |
473 |
446 |
$8K |
| A7030 |
Full face mask used with positive airway pressure device, each |
74 |
72 |
$8K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
274 |
230 |
$7K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
88 |
82 |
$6K |
| E1392 |
Portable oxygen concentrator, rental |
220 |
194 |
$6K |
| A7037 |
Tubing used with positive airway pressure device |
198 |
194 |
$5K |
| K0001 |
Standard wheelchair |
268 |
223 |
$4K |
| A7031 |
Face mask interface, replacement for full face mask, each |
100 |
97 |
$4K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
75 |
51 |
$4K |
| A7035 |
Headgear used with positive airway pressure device |
160 |
155 |
$4K |
| 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 |
25 |
24 |
$3K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
34 |
33 |
$2K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
335 |
324 |
$2K |
| K0002 |
Standard hemi (low seat) wheelchair |
134 |
97 |
$2K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
33 |
31 |
$1K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
17 |
16 |
$899.16 |
| B9998 |
Noc for enteral supplies |
27 |
24 |
$870.27 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
232 |
206 |
$655.59 |
| A4670 |
Automatic blood pressure monitor |
12 |
12 |
$573.52 |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
16 |
12 |
$180.60 |
| A4456 |
Adhesive remover, wipes, any type, each |
30 |
25 |
$105.83 |
| A5120 |
Skin barrier, wipes or swabs, each |
37 |
37 |
$94.55 |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
24 |
24 |
$87.48 |
| A7000 |
Canister, disposable, used with suction pump, each |
12 |
12 |
$59.29 |
| A7002 |
Tubing, used with suction pump, each |
12 |
12 |
$40.80 |