| 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 |
2,486 |
1,772 |
$162K |
| 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 |
1,005 |
859 |
$24K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
646 |
448 |
$19K |
| K0003 |
Lightweight wheelchair |
367 |
311 |
$12K |
| 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 |
102 |
61 |
$7K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
410 |
343 |
$4K |
| E0601 |
Continuous positive airway pressure (cpap) device |
96 |
76 |
$3K |
| A4554 |
Disposable underpads, all sizes |
56 |
54 |
$3K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
154 |
130 |
$3K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
56 |
24 |
$2K |
| E1392 |
Portable oxygen concentrator, rental |
47 |
42 |
$1K |
| K0001 |
Standard wheelchair |
70 |
51 |
$976.53 |
| E0570 |
Nebulizer, with compressor |
73 |
65 |
$974.90 |
| A7030 |
Full face mask used with positive airway pressure device, each |
14 |
12 |
$697.35 |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
23 |
14 |
$566.98 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
13 |
12 |
$531.89 |
| A7035 |
Headgear used with positive airway pressure device |
14 |
13 |
$190.59 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
69 |
54 |
$159.00 |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
14 |
12 |
$116.95 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
13 |
13 |
$20.80 |