| 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 |
3,434 |
3,418 |
$239K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
3,847 |
3,796 |
$238K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,414 |
1,396 |
$182K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,542 |
1,526 |
$158K |
| T4541 |
Incontinence product, disposable underpad, large, each |
3,484 |
3,470 |
$146K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
815 |
807 |
$75K |
| E0570 |
Nebulizer, with compressor |
1,824 |
1,817 |
$59K |
| K0001 |
Standard wheelchair |
2,056 |
2,045 |
$46K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,646 |
2,636 |
$29K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
900 |
899 |
$23K |
| S5161 |
Emergency response system; service fee, per month (excludes installation and testing) |
507 |
506 |
$18K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
59 |
59 |
$14K |
| E0601 |
Continuous positive airway pressure (cpap) device |
308 |
308 |
$9K |
| A4927 |
Gloves, non-sterile, per 100 |
431 |
408 |
$8K |
| A7030 |
Full face mask used with positive airway pressure device, each |
94 |
94 |
$6K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
227 |
226 |
$5K |
| A4335 |
Incontinence supply; miscellaneous |
332 |
332 |
$5K |
| A7035 |
Headgear used with positive airway pressure device |
107 |
107 |
$2K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
66 |
66 |
$1K |
| A7037 |
Tubing used with positive airway pressure device |
126 |
126 |
$1K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
280 |
280 |
$820.63 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
12 |
12 |
$466.56 |
| A7031 |
Face mask interface, replacement for full face mask, each |
54 |
54 |
$294.97 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
130 |
130 |
$281.90 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
28 |
28 |
$52.12 |