| 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 |
4,231 |
4,211 |
$214K |
| 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 |
2,402 |
2,203 |
$166K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
3,334 |
3,317 |
$73K |
| K0003 |
Lightweight wheelchair |
3,089 |
3,051 |
$66K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,163 |
1,161 |
$45K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
954 |
951 |
$26K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,609 |
1,600 |
$24K |
| E0570 |
Nebulizer, with compressor |
1,411 |
1,403 |
$17K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
262 |
242 |
$12K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
508 |
497 |
$12K |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
463 |
454 |
$10K |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
129 |
120 |
$9K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
863 |
862 |
$7K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
704 |
430 |
$7K |
| 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 |
821 |
819 |
$6K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
513 |
512 |
$5K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
704 |
431 |
$5K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
419 |
257 |
$4K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
143 |
142 |
$4K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
89 |
79 |
$4K |
| A7030 |
Full face mask used with positive airway pressure device, each |
81 |
80 |
$3K |
| S5199 |
Personal care item, nos, each |
226 |
215 |
$3K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
92 |
92 |
$3K |
| E1392 |
Portable oxygen concentrator, rental |
548 |
548 |
$3K |
| A7037 |
Tubing used with positive airway pressure device |
205 |
204 |
$2K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
448 |
283 |
$2K |
| A7035 |
Headgear used with positive airway pressure device |
165 |
163 |
$2K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
144 |
133 |
$2K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
26 |
25 |
$2K |
| E0184 |
Dry pressure mattress |
59 |
59 |
$1K |
| A4259 |
Lancets, per box of 100 |
410 |
403 |
$1K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
347 |
344 |
$1K |
| E0156 |
Seat attachment, walker |
127 |
126 |
$753.50 |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
25 |
25 |
$490.52 |
| A7015 |
Aerosol mask, used with dme nebulizer |
449 |
448 |
$468.11 |
| A7000 |
Canister, disposable, used with suction pump, each |
83 |
76 |
$352.30 |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
46 |
38 |
$306.34 |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
37 |
37 |
$263.56 |
| A7526 |
Tracheostomy tube collar/holder, each |
15 |
12 |
$177.84 |
| E0561 |
Humidifier, non-heated, used with positive airway pressure device |
24 |
24 |
$160.77 |
| A7002 |
Tubing, used with suction pump, each |
68 |
63 |
$108.72 |