| 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 |
2,885 |
2,776 |
$303K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
702 |
607 |
$91K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
663 |
653 |
$84K |
| E0570 |
Nebulizer, with compressor |
4,382 |
4,349 |
$67K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,150 |
2,064 |
$53K |
| E0601 |
Continuous positive airway pressure (cpap) device |
690 |
679 |
$46K |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
319 |
274 |
$41K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
374 |
373 |
$30K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
787 |
784 |
$24K |
| K0001 |
Standard wheelchair |
507 |
496 |
$20K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
409 |
379 |
$17K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
106 |
100 |
$16K |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
236 |
236 |
$16K |
| B9002 |
Enteral nutrition infusion pump, any type |
348 |
311 |
$14K |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
216 |
215 |
$12K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
103 |
101 |
$11K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
647 |
643 |
$8K |
| 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) |
42 |
39 |
$6K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
209 |
207 |
$6K |
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
67 |
54 |
$5K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
90 |
80 |
$4K |
| L3260 |
Surgical boot/shoe, each |
77 |
76 |
$4K |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
583 |
576 |
$4K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
35 |
25 |
$3K |
| L4360 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
16 |
16 |
$3K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
71 |
67 |
$2K |
| A5120 |
Skin barrier, wipes or swabs, each |
351 |
343 |
$2K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
46 |
43 |
$2K |
| E0776 |
Iv pole |
400 |
398 |
$2K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
421 |
253 |
$2K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
85 |
85 |
$1K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
119 |
108 |
$1K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
24 |
24 |
$1K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
25 |
24 |
$1K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
115 |
111 |
$1K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
38 |
36 |
$698.53 |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
27 |
25 |
$641.48 |
| A4456 |
Adhesive remover, wipes, any type, each |
197 |
190 |
$588.33 |
| A4452 |
Tape, waterproof, per 18 square inches |
14 |
12 |
$346.49 |
| A4371 |
Ostomy skin barrier, powder, per oz |
179 |
177 |
$329.40 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
46 |
44 |
$136.33 |
| A7015 |
Aerosol mask, used with dme nebulizer |
91 |
91 |
$89.89 |
| A7002 |
Tubing, used with suction pump, each |
24 |
24 |
$81.28 |
| A4367 |
Ostomy belt, each |
13 |
13 |
$66.24 |