| 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 |
12,349 |
11,792 |
$593K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
728 |
689 |
$155K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,360 |
1,335 |
$118K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,163 |
2,092 |
$85K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,998 |
1,959 |
$57K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
6,070 |
5,844 |
$55K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
327 |
320 |
$52K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,605 |
1,560 |
$43K |
| E1392 |
Portable oxygen concentrator, rental |
2,843 |
2,718 |
$39K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
286 |
286 |
$38K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
556 |
547 |
$38K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
564 |
557 |
$29K |
| A7035 |
Headgear used with positive airway pressure device |
1,392 |
1,359 |
$22K |
| E0570 |
Nebulizer, with compressor |
1,212 |
1,136 |
$20K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
384 |
376 |
$19K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
665 |
596 |
$18K |
| 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) |
168 |
160 |
$18K |
| K0001 |
Standard wheelchair |
1,317 |
1,279 |
$16K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
159 |
142 |
$16K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
169 |
169 |
$15K |
| T4541 |
Incontinence product, disposable underpad, large, each |
599 |
574 |
$12K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
269 |
261 |
$12K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
130 |
125 |
$11K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,788 |
2,704 |
$11K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
288 |
281 |
$8K |
| E0434 |
Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing |
1,372 |
1,261 |
$8K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
81 |
75 |
$7K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
637 |
629 |
$6K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
48 |
40 |
$4K |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
260 |
260 |
$4K |
| A4927 |
Gloves, non-sterile, per 100 |
310 |
288 |
$4K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
24 |
24 |
$3K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
148 |
146 |
$3K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
36 |
25 |
$2K |
| E2103 |
Non-adjunctive, non-implanted continuous glucose monitor or receiver |
12 |
12 |
$2K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
21 |
13 |
$955.10 |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
12 |
12 |
$535.30 |
| 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 |
17 |
12 |
$438.76 |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
12 |
12 |
$422.06 |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
49 |
47 |
$302.25 |
| A7002 |
Tubing, used with suction pump, each |
16 |
15 |
$88.67 |