| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
2,791 |
2,665 |
$94K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
646 |
631 |
$78K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,531 |
1,494 |
$52K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
453 |
428 |
$41K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,146 |
1,094 |
$37K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,892 |
1,852 |
$31K |
| A4335 |
Incontinence supply; miscellaneous |
3,445 |
3,299 |
$17K |
| E1035 |
Multi-positional patient transfer system, with integrated seat, operated by care giver, patient weight capacity up to and including 300 lbs |
1,709 |
1,435 |
$16K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
881 |
863 |
$15K |
| K0001 |
Standard wheelchair |
1,930 |
1,913 |
$9K |
| K0003 |
Lightweight wheelchair |
893 |
884 |
$7K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
416 |
413 |
$6K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
143 |
133 |
$5K |
| A7031 |
Face mask interface, replacement for full face mask, each |
100 |
96 |
$3K |
| A7030 |
Full face mask used with positive airway pressure device, each |
51 |
50 |
$3K |
| A7037 |
Tubing used with positive airway pressure device |
151 |
145 |
$2K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
362 |
344 |
$1K |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
30 |
29 |
$1K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
114 |
109 |
$743.87 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
90 |
88 |
$676.37 |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
124 |
122 |
$670.78 |
| E0156 |
Seat attachment, walker |
396 |
395 |
$576.92 |
| A7035 |
Headgear used with positive airway pressure device |
56 |
56 |
$428.40 |
| 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) |
28 |
25 |
$426.64 |
| E2602 |
General use wheelchair seat cushion, width 22 inches or greater, any depth |
31 |
31 |
$268.59 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
208 |
150 |
$252.44 |
| K0002 |
Standard hemi (low seat) wheelchair |
25 |
25 |
$199.37 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
14 |
14 |
$15.66 |