| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4927 |
Gloves, non-sterile, per 100 |
9,816 |
9,332 |
$82K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,131 |
1,029 |
$51K |
| E0570 |
Nebulizer, with compressor |
699 |
687 |
$27K |
| E0601 |
Continuous positive airway pressure (cpap) device |
672 |
642 |
$26K |
| K0001 |
Standard wheelchair |
1,270 |
1,146 |
$24K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
391 |
374 |
$22K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
473 |
410 |
$18K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
232 |
211 |
$6K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
25 |
25 |
$4K |
| 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 |
172 |
171 |
$3K |
| K0003 |
Lightweight wheelchair |
99 |
89 |
$2K |
| A7037 |
Tubing used with positive airway pressure device |
119 |
107 |
$2K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
252 |
229 |
$1K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
181 |
150 |
$1K |
| A7031 |
Face mask interface, replacement for full face mask, each |
24 |
24 |
$1K |
| A7030 |
Full face mask used with positive airway pressure device, each |
12 |
12 |
$970.57 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
197 |
192 |
$787.41 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
137 |
129 |
$610.89 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
50 |
37 |
$511.25 |
| A7015 |
Aerosol mask, used with dme nebulizer |
163 |
159 |
$314.94 |
| T5999 |
Supply, not otherwise specified |
70 |
64 |
$266.92 |
| A4554 |
Disposable underpads, all sizes |
16 |
12 |
$196.68 |