| 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 |
9,828 |
9,343 |
$880K |
| E0601 |
Continuous positive airway pressure (cpap) device |
7,825 |
6,937 |
$337K |
| E0570 |
Nebulizer, with compressor |
2,452 |
2,342 |
$202K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,332 |
2,245 |
$188K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
10,303 |
9,814 |
$170K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,985 |
1,875 |
$98K |
| A7031 |
Face mask interface, replacement for full face mask, each |
2,832 |
2,655 |
$91K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
792 |
753 |
$76K |
| K0001 |
Standard wheelchair |
2,784 |
2,588 |
$52K |
| A7037 |
Tubing used with positive airway pressure device |
4,326 |
4,053 |
$52K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,905 |
1,613 |
$49K |
| A7035 |
Headgear used with positive airway pressure device |
2,880 |
2,703 |
$47K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
1,909 |
1,596 |
$42K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
964 |
917 |
$36K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
9,227 |
8,327 |
$36K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
309 |
294 |
$33K |
| 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 |
768 |
593 |
$28K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
617 |
576 |
$23K |
| 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) |
259 |
250 |
$22K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,901 |
1,822 |
$21K |
| A4670 |
Automatic blood pressure monitor |
688 |
674 |
$20K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
467 |
445 |
$14K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
455 |
426 |
$13K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
429 |
395 |
$11K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
577 |
569 |
$8K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
736 |
662 |
$7K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
1,497 |
1,396 |
$7K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
652 |
623 |
$7K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
680 |
652 |
$5K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
140 |
137 |
$5K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
73 |
73 |
$3K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
163 |
163 |
$3K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
660 |
642 |
$1K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,007 |
968 |
$1K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
31 |
31 |
$973.33 |
| E0156 |
Seat attachment, walker |
64 |
55 |
$864.32 |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
14 |
12 |
$346.89 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
13 |
12 |
$292.31 |
| A5120 |
Skin barrier, wipes or swabs, each |
13 |
13 |
$144.66 |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
12 |
12 |
$138.89 |
| A4649 |
Surgical supply; miscellaneous |
17 |
12 |
$79.14 |
| K0003 |
Lightweight wheelchair |
12 |
12 |
$71.10 |
| A7002 |
Tubing, used with suction pump, each |
33 |
24 |
$60.65 |
| A7000 |
Canister, disposable, used with suction pump, each |
12 |
12 |
$28.91 |
| B9002 |
Enteral nutrition infusion pump, any type |
19 |
19 |
$0.00 |