| 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 |
4,060 |
3,510 |
$102K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,843 |
2,528 |
$42K |
| L3660 |
Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf |
848 |
762 |
$40K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,307 |
1,016 |
$34K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
327 |
297 |
$29K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
685 |
577 |
$27K |
| 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 |
865 |
631 |
$26K |
| 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 |
407 |
307 |
$9K |
| K0001 |
Standard wheelchair |
1,066 |
862 |
$8K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
84 |
50 |
$4K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
188 |
146 |
$2K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
56 |
53 |
$967.24 |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
54 |
51 |
$817.34 |
| B9002 |
Enteral nutrition infusion pump, any type |
62 |
52 |
$791.29 |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
27 |
27 |
$746.70 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
45 |
37 |
$245.21 |