| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
4,055 |
3,958 |
$529K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,034 |
1,828 |
$66K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,011 |
886 |
$60K |
| A4554 |
Disposable underpads, all sizes |
765 |
748 |
$26K |
| E1392 |
Portable oxygen concentrator, rental |
1,505 |
1,347 |
$20K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
328 |
276 |
$18K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,072 |
939 |
$14K |
| A7031 |
Face mask interface, replacement for full face mask, each |
401 |
386 |
$12K |
| A7037 |
Tubing used with positive airway pressure device |
923 |
848 |
$11K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
50 |
37 |
$10K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
55 |
40 |
$9K |
| A7030 |
Full face mask used with positive airway pressure device, each |
93 |
87 |
$7K |
| A7035 |
Headgear used with positive airway pressure device |
517 |
472 |
$7K |
| E0570 |
Nebulizer, with compressor |
439 |
404 |
$6K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
604 |
273 |
$5K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,620 |
1,510 |
$5K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
374 |
264 |
$5K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
418 |
184 |
$3K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
12 |
12 |
$3K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
27 |
27 |
$2K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
25 |
24 |
$2K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
188 |
178 |
$870.88 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
310 |
289 |
$759.34 |
| K0040 |
Adjustable angle footplate, each |
62 |
25 |
$686.67 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
95 |
88 |
$554.33 |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
12 |
12 |
$530.30 |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
93 |
38 |
$225.96 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
13 |
12 |
$2.29 |