| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A7030 |
Full face mask used with positive airway pressure device, each |
2,288 |
2,207 |
$174K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,390 |
2,344 |
$106K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
3,250 |
3,121 |
$94K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,405 |
2,350 |
$92K |
| A7031 |
Face mask interface, replacement for full face mask, each |
2,491 |
2,379 |
$90K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,514 |
1,456 |
$80K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
937 |
889 |
$38K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,826 |
1,776 |
$38K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,630 |
1,564 |
$37K |
| A7035 |
Headgear used with positive airway pressure device |
2,142 |
2,064 |
$32K |
| E0570 |
Nebulizer, with compressor |
1,476 |
1,467 |
$25K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,960 |
3,810 |
$19K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,664 |
1,603 |
$18K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,747 |
1,681 |
$16K |
| K0001 |
Standard wheelchair |
1,089 |
1,032 |
$10K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
295 |
288 |
$9K |
| S9999 |
Sales tax |
900 |
826 |
$9K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
245 |
238 |
$7K |
| A7037 |
Tubing used with positive airway pressure device |
225 |
218 |
$4K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
13 |
13 |
$3K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
12 |
12 |
$2K |
| E1392 |
Portable oxygen concentrator, rental |
139 |
139 |
$2K |
| K0003 |
Lightweight wheelchair |
185 |
168 |
$2K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
81 |
79 |
$2K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
239 |
222 |
$1K |
| E0156 |
Seat attachment, walker |
116 |
115 |
$971.32 |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
362 |
358 |
$808.44 |
| A4927 |
Gloves, non-sterile, per 100 |
15 |
13 |
$798.07 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
81 |
81 |
$577.91 |
| T4541 |
Incontinence product, disposable underpad, large, each |
12 |
12 |
$504.00 |
| E0245 |
Tub stool or bench |
12 |
12 |
$495.00 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
156 |
154 |
$358.75 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
64 |
25 |
$41.24 |