| 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 |
8,267 |
7,310 |
$227K |
| E0570 |
Nebulizer, with compressor |
2,866 |
2,579 |
$68K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
2,695 |
2,258 |
$58K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
5,793 |
5,151 |
$41K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,036 |
915 |
$31K |
| K0001 |
Standard wheelchair |
2,760 |
2,424 |
$27K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
415 |
303 |
$25K |
| 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 |
399 |
305 |
$21K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
314 |
227 |
$10K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,201 |
1,080 |
$8K |
| A7031 |
Face mask interface, replacement for full face mask, each |
176 |
150 |
$3K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,248 |
1,088 |
$3K |
| 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 |
14 |
12 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
892 |
844 |
$1K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
41 |
41 |
$1K |
| A7035 |
Headgear used with positive airway pressure device |
107 |
97 |
$1K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
46 |
37 |
$709.88 |
| A7030 |
Full face mask used with positive airway pressure device, each |
13 |
13 |
$604.79 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
60 |
51 |
$422.35 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
151 |
135 |
$396.78 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
12 |
12 |
$199.67 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
18 |
12 |
$107.64 |
| A7037 |
Tubing used with positive airway pressure device |
18 |
12 |
$92.57 |
| A4259 |
Lancets, per box of 100 |
119 |
107 |
$36.40 |