| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0603 |
Breast pump, electric (ac and/or dc), any type |
2,149 |
1,792 |
$325K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
3,922 |
3,013 |
$115K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,367 |
1,115 |
$43K |
| 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 |
2,154 |
1,571 |
$31K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,023 |
876 |
$26K |
| A7031 |
Face mask interface, replacement for full face mask, each |
706 |
586 |
$17K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
851 |
692 |
$12K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
311 |
294 |
$10K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
367 |
264 |
$10K |
| L3660 |
Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf |
180 |
162 |
$10K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
298 |
267 |
$9K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
183 |
164 |
$7K |
| A7037 |
Tubing used with positive airway pressure device |
712 |
594 |
$6K |
| K0001 |
Standard wheelchair |
658 |
531 |
$6K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,787 |
1,350 |
$5K |
| A7035 |
Headgear used with positive airway pressure device |
387 |
326 |
$4K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
505 |
421 |
$4K |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
69 |
58 |
$4K |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
41 |
37 |
$2K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
300 |
247 |
$2K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
17 |
14 |
$2K |
| E0570 |
Nebulizer, with compressor |
187 |
155 |
$2K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
407 |
342 |
$2K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
52 |
38 |
$2K |
| A7030 |
Full face mask used with positive airway pressure device, each |
43 |
27 |
$890.66 |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
23 |
21 |
$743.47 |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
61 |
50 |
$710.89 |
| L3260 |
Surgical boot/shoe, each |
39 |
31 |
$536.26 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
126 |
89 |
$366.42 |
| K0003 |
Lightweight wheelchair |
33 |
26 |
$334.95 |