| 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 |
6,784 |
5,716 |
$345K |
| E0601 |
Continuous positive airway pressure (cpap) device |
3,119 |
2,753 |
$168K |
| E0570 |
Nebulizer, with compressor |
4,865 |
4,113 |
$55K |
| A7030 |
Full face mask used with positive airway pressure device, each |
581 |
500 |
$49K |
| K0001 |
Standard wheelchair |
3,680 |
3,191 |
$38K |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
2,023 |
1,731 |
$31K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
5,868 |
4,881 |
$29K |
| A7035 |
Headgear used with positive airway pressure device |
730 |
614 |
$13K |
| A7037 |
Tubing used with positive airway pressure device |
566 |
490 |
$12K |
| A7031 |
Face mask interface, replacement for full face mask, each |
245 |
214 |
$9K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,318 |
1,103 |
$6K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
154 |
142 |
$3K |
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 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 |
27 |
12 |
$2K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
26 |
25 |
$2K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
45 |
40 |
$2K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
27 |
27 |
$2K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
132 |
122 |
$1K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
254 |
239 |
$973.83 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
28 |
25 |
$898.84 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
102 |
101 |
$587.40 |
| A4259 |
Lancets, per box of 100 |
141 |
138 |
$45.31 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
13 |
12 |
$17.60 |
| A7015 |
Aerosol mask, used with dme nebulizer |
13 |
12 |
$12.00 |
| 90662 |
|
34 |
34 |
$0.00 |
| 0011A |
|
112 |
112 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
86 |
86 |
$0.00 |
| 0012A |
|
111 |
111 |
$0.00 |
| 90688 |
|
12 |
12 |
$0.00 |
| 0001A |
|
12 |
12 |
$0.00 |
| 90694 |
|
27 |
27 |
$0.00 |