| 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 |
3,581 |
3,237 |
$264K |
| E0601 |
Continuous positive airway pressure (cpap) device |
3,272 |
3,031 |
$206K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,953 |
1,849 |
$201K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,741 |
1,576 |
$96K |
| E0570 |
Nebulizer, with compressor |
2,015 |
1,838 |
$83K |
| S5161 |
Emergency response system; service fee, per month (excludes installation and testing) |
1,835 |
1,774 |
$54K |
| 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 |
1,968 |
1,824 |
$49K |
| A7035 |
Headgear used with positive airway pressure device |
1,770 |
1,657 |
$37K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,891 |
2,727 |
$19K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
319 |
302 |
$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) |
93 |
89 |
$9K |
| K0001 |
Standard wheelchair |
434 |
367 |
$8K |
| S5170 |
Home delivered meals, including preparation; per meal |
297 |
279 |
$6K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
528 |
509 |
$6K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,576 |
1,502 |
$5K |
| A4452 |
Tape, waterproof, per 18 square inches |
1,001 |
593 |
$4K |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
42 |
28 |
$4K |
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
28 |
13 |
$3K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
770 |
732 |
$3K |
| A7037 |
Tubing used with positive airway pressure device |
818 |
753 |
$2K |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
13 |
13 |
$1K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
226 |
174 |
$1K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
24 |
24 |
$796.02 |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
25 |
24 |
$788.55 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
95 |
92 |
$760.45 |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
125 |
77 |
$724.53 |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
28 |
13 |
$621.68 |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
15 |
12 |
$522.46 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
66 |
39 |
$462.47 |
| A4660 |
Sphygmomanometer/blood pressure apparatus with cuff and stethoscope |
13 |
13 |
$222.23 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
38 |
26 |
$113.94 |