| 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 |
10,654 |
10,443 |
$925K |
| E0601 |
Continuous positive airway pressure (cpap) device |
8,113 |
8,015 |
$379K |
| E0570 |
Nebulizer, with compressor |
7,812 |
7,742 |
$222K |
| 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) |
1,800 |
1,792 |
$205K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
1,575 |
1,571 |
$190K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
6,659 |
6,518 |
$137K |
| K0003 |
Lightweight wheelchair |
1,965 |
1,948 |
$98K |
| 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 |
1,110 |
1,058 |
$95K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
2,988 |
2,935 |
$82K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,731 |
1,720 |
$77K |
| K0001 |
Standard wheelchair |
3,067 |
3,015 |
$77K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,259 |
1,245 |
$74K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,141 |
1,125 |
$58K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
530 |
508 |
$44K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,246 |
1,182 |
$40K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
824 |
650 |
$38K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
1,354 |
1,243 |
$30K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,919 |
1,910 |
$30K |
| 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 |
233 |
230 |
$26K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
774 |
756 |
$24K |
| K0004 |
High strength, lightweight wheelchair |
304 |
304 |
$22K |
| A7035 |
Headgear used with positive airway pressure device |
1,682 |
1,652 |
$21K |
| A7037 |
Tubing used with positive airway pressure device |
1,446 |
1,414 |
$18K |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
310 |
290 |
$17K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
465 |
465 |
$17K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,872 |
1,838 |
$16K |
| E1392 |
Portable oxygen concentrator, rental |
2,259 |
2,202 |
$15K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
385 |
366 |
$14K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,720 |
2,697 |
$11K |
| K0007 |
Extra heavy duty wheelchair |
241 |
240 |
$11K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,222 |
1,195 |
$10K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
680 |
668 |
$10K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
387 |
371 |
$8K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,163 |
1,151 |
$7K |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
414 |
411 |
$6K |
| E0156 |
Seat attachment, walker |
634 |
634 |
$5K |
| A4259 |
Lancets, per box of 100 |
1,099 |
1,042 |
$4K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
69 |
67 |
$4K |
| A5120 |
Skin barrier, wipes or swabs, each |
509 |
497 |
$3K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
126 |
121 |
$3K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
534 |
530 |
$2K |
| 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 |
14 |
14 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,124 |
1,119 |
$2K |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
26 |
26 |
$2K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,357 |
1,345 |
$2K |
| E0607 |
Home blood glucose monitor |
57 |
56 |
$2K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
130 |
130 |
$2K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
161 |
157 |
$1K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
12 |
12 |
$1K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
93 |
91 |
$1K |
| A7031 |
Face mask interface, replacement for full face mask, each |
55 |
55 |
$1K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
102 |
102 |
$1K |
| B9002 |
Enteral nutrition infusion pump, any type |
38 |
38 |
$746.58 |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
43 |
18 |
$733.76 |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
27 |
27 |
$721.53 |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
12 |
12 |
$601.77 |
| A4456 |
Adhesive remover, wipes, any type, each |
51 |
49 |
$294.62 |
| A4256 |
Normal, low and high calibrator solution / chips |
52 |
52 |
$259.92 |
| A7036 |
Chinstrap used with positive airway pressure device |
38 |
38 |
$228.62 |
| E0776 |
Iv pole |
89 |
89 |
$201.44 |
| A4335 |
Incontinence supply; miscellaneous |
115 |
114 |
$180.74 |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
13 |
12 |
$156.64 |
| E0561 |
Humidifier, non-heated, used with positive airway pressure device |
13 |
13 |
$153.66 |