| 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 |
13,210 |
13,108 |
$1.02M |
| E0601 |
Continuous positive airway pressure (cpap) device |
6,922 |
6,904 |
$397K |
| A7030 |
Full face mask used with positive airway pressure device, each |
3,429 |
3,420 |
$198K |
| E0570 |
Nebulizer, with compressor |
4,331 |
4,320 |
$192K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
10,074 |
9,996 |
$159K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
901 |
881 |
$145K |
| 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) |
1,052 |
1,049 |
$117K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
817 |
809 |
$108K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
1,957 |
1,821 |
$88K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,197 |
1,181 |
$63K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
5,582 |
5,572 |
$57K |
| A7037 |
Tubing used with positive airway pressure device |
3,551 |
3,540 |
$48K |
| K0003 |
Lightweight wheelchair |
1,477 |
1,466 |
$48K |
| A7035 |
Headgear used with positive airway pressure device |
2,726 |
2,717 |
$46K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
1,307 |
1,287 |
$39K |
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
230 |
207 |
$23K |
| A7031 |
Face mask interface, replacement for full face mask, each |
923 |
922 |
$18K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
302 |
301 |
$17K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,807 |
1,799 |
$9K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
255 |
241 |
$9K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,495 |
2,489 |
$8K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
955 |
935 |
$8K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
3,287 |
3,276 |
$6K |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
181 |
179 |
$3K |
| L1812 |
Knee orthosis, elastic with joints, prefabricated, off-the-shelf |
44 |
36 |
$2K |
| A4670 |
Automatic blood pressure monitor |
31 |
31 |
$2K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
39 |
37 |
$2K |
| E1392 |
Portable oxygen concentrator, rental |
127 |
127 |
$1K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
752 |
751 |
$982.82 |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
28 |
27 |
$972.63 |
| E0156 |
Seat attachment, walker |
88 |
87 |
$607.61 |
| A4259 |
Lancets, per box of 100 |
176 |
174 |
$207.41 |
| A5120 |
Skin barrier, wipes or swabs, each |
13 |
13 |
$55.86 |
| A7015 |
Aerosol mask, used with dme nebulizer |
39 |
37 |
$47.85 |