| 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 |
12,060 |
10,021 |
$614K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,853 |
2,507 |
$244K |
| E0601 |
Continuous positive airway pressure (cpap) device |
4,333 |
3,929 |
$219K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
4,283 |
3,762 |
$126K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,492 |
1,320 |
$121K |
| A7031 |
Face mask interface, replacement for full face mask, each |
3,103 |
2,722 |
$102K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,812 |
1,608 |
$100K |
| 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) |
1,089 |
955 |
$96K |
| E0570 |
Nebulizer, with compressor |
8,074 |
7,128 |
$80K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
6,606 |
5,461 |
$56K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,031 |
924 |
$52K |
| A7035 |
Headgear used with positive airway pressure device |
2,969 |
2,596 |
$52K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
354 |
329 |
$51K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
544 |
509 |
$50K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,156 |
1,015 |
$39K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
265 |
255 |
$38K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
7,105 |
6,228 |
$35K |
| K0001 |
Standard wheelchair |
2,328 |
1,800 |
$32K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,497 |
1,333 |
$28K |
| A4927 |
Gloves, non-sterile, per 100 |
2,290 |
1,632 |
$26K |
| E1392 |
Portable oxygen concentrator, rental |
2,168 |
1,743 |
$25K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
930 |
707 |
$19K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
618 |
542 |
$14K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,658 |
1,438 |
$14K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
636 |
579 |
$11K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
1,424 |
1,214 |
$9K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
105 |
93 |
$8K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
148 |
129 |
$6K |
| A7015 |
Aerosol mask, used with dme nebulizer |
967 |
854 |
$941.33 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
434 |
407 |
$876.25 |
| A4456 |
Adhesive remover, wipes, any type, each |
81 |
80 |
$592.27 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
42 |
37 |
$330.33 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
268 |
177 |
$0.00 |