| 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 |
524 |
489 |
$22K |
| E0601 |
Continuous positive airway pressure (cpap) device |
501 |
429 |
$21K |
| 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 |
125 |
120 |
$13K |
| 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) |
110 |
89 |
$11K |
| K0001 |
Standard wheelchair |
236 |
211 |
$7K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
211 |
195 |
$3K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
98 |
78 |
$3K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
93 |
80 |
$3K |
| A7037 |
Tubing used with positive airway pressure device |
184 |
157 |
$3K |
| A7035 |
Headgear used with positive airway pressure device |
166 |
143 |
$3K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
86 |
68 |
$3K |
| A7030 |
Full face mask used with positive airway pressure device, each |
20 |
19 |
$2K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
452 |
369 |
$949.39 |
| 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 |
27 |
13 |
$925.00 |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
28 |
26 |
$545.00 |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
14 |
13 |
$454.08 |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
19 |
16 |
$303.90 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
22 |
19 |
$277.39 |
| E0570 |
Nebulizer, with compressor |
20 |
13 |
$272.80 |
| A4927 |
Gloves, non-sterile, per 100 |
17 |
15 |
$244.62 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
21 |
18 |
$130.92 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
14 |
12 |
$46.71 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
14 |
13 |
$42.28 |