| 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 |
3,768 |
3,495 |
$279K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,278 |
1,209 |
$115K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,522 |
2,337 |
$102K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
838 |
650 |
$64K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,711 |
1,590 |
$62K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,761 |
1,677 |
$60K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,035 |
903 |
$54K |
| A4927 |
Gloves, non-sterile, per 100 |
1,947 |
1,733 |
$47K |
| S5161 |
Emergency response system; service fee, per month (excludes installation and testing) |
862 |
771 |
$42K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,789 |
2,540 |
$41K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
339 |
302 |
$40K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
833 |
768 |
$37K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,049 |
950 |
$28K |
| A7035 |
Headgear used with positive airway pressure device |
1,224 |
1,177 |
$23K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
335 |
315 |
$16K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,780 |
2,609 |
$14K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
134 |
110 |
$9K |
| E1392 |
Portable oxygen concentrator, rental |
205 |
203 |
$5K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
17 |
12 |
$5K |
| E0570 |
Nebulizer, with compressor |
407 |
384 |
$3K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
121 |
105 |
$3K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
304 |
279 |
$3K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
51 |
39 |
$2K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
40 |
29 |
$1K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
18 |
13 |
$1K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
31 |
26 |
$1K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
17 |
12 |
$755.32 |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
31 |
26 |
$291.39 |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
17 |
13 |
$207.78 |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
38 |
35 |
$185.36 |
| K0001 |
Standard wheelchair |
30 |
26 |
$85.28 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
31 |
29 |
$33.76 |
| 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) |
13 |
13 |
$0.00 |