| 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 |
77,194 |
68,599 |
$4.21M |
| E0601 |
Continuous positive airway pressure (cpap) device |
24,790 |
22,331 |
$1.06M |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
47,094 |
41,767 |
$926K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
15,276 |
14,382 |
$827K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
7,382 |
6,915 |
$770K |
| 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) |
7,340 |
6,475 |
$769K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
20,210 |
19,274 |
$706K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
7,231 |
6,761 |
$668K |
| E0570 |
Nebulizer, with compressor |
16,294 |
13,953 |
$627K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
5,170 |
4,815 |
$592K |
| A7030 |
Full face mask used with positive airway pressure device, each |
9,841 |
8,741 |
$583K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
2,468 |
2,235 |
$566K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
1,617 |
973 |
$564K |
| 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 |
6,776 |
5,218 |
$499K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
13,319 |
11,176 |
$474K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
11,085 |
9,727 |
$309K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
2,188 |
1,815 |
$307K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
7,406 |
6,485 |
$301K |
| K0001 |
Standard wheelchair |
9,540 |
8,181 |
$265K |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
1,669 |
1,366 |
$262K |
| E0471 |
Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
1,511 |
1,235 |
$259K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
6,453 |
5,731 |
$233K |
| 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 |
1,895 |
1,563 |
$225K |
| A7035 |
Headgear used with positive airway pressure device |
11,988 |
10,709 |
$221K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
2,704 |
2,008 |
$202K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,958 |
1,270 |
$194K |
| A7031 |
Face mask interface, replacement for full face mask, each |
7,765 |
6,618 |
$190K |
| 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 |
1,783 |
1,321 |
$187K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
515 |
405 |
$170K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,721 |
1,580 |
$150K |
| A4670 |
Automatic blood pressure monitor |
3,637 |
3,467 |
$135K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,608 |
1,458 |
$134K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
1,877 |
1,381 |
$130K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
1,800 |
1,319 |
$125K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
895 |
613 |
$114K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
1,221 |
1,107 |
$103K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
8,266 |
7,522 |
$102K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
2,582 |
2,105 |
$88K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
2,906 |
2,648 |
$88K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
719 |
684 |
$83K |
| E1392 |
Portable oxygen concentrator, rental |
2,630 |
2,357 |
$79K |
| A7037 |
Tubing used with positive airway pressure device |
5,366 |
4,834 |
$79K |
| A4927 |
Gloves, non-sterile, per 100 |
6,006 |
5,536 |
$75K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
803 |
705 |
$74K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
562 |
531 |
$73K |
| B9998 |
Noc for enteral supplies |
2,170 |
1,179 |
$69K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
887 |
694 |
$68K |
| L3670 |
Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf |
1,595 |
1,456 |
$67K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
22,487 |
18,914 |
$62K |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
3,420 |
3,243 |
$62K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
2,752 |
2,242 |
$59K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
2,887 |
2,486 |
$58K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
2,729 |
2,552 |
$55K |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
1,024 |
858 |
$53K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
338 |
235 |
$52K |
| E0245 |
Tub stool or bench |
1,506 |
1,420 |
$48K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,432 |
3,664 |
$48K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
13,911 |
6,089 |
$47K |
| K0007 |
Extra heavy duty wheelchair |
528 |
445 |
$42K |
| A4217 |
Sterile water/saline, 500 ml |
1,673 |
1,228 |
$40K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
1,086 |
667 |
$40K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
1,195 |
999 |
$39K |
| E0619 |
Apnea monitor, with recording feature |
210 |
201 |
$39K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
452 |
381 |
$38K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
1,887 |
1,571 |
$38K |
| A7526 |
Tracheostomy tube collar/holder, each |
1,632 |
1,243 |
$38K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
1,322 |
1,156 |
$35K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
430 |
367 |
$35K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
743 |
596 |
$33K |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
699 |
673 |
$31K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
1,727 |
1,004 |
$31K |
| A4452 |
Tape, waterproof, per 18 square inches |
1,127 |
977 |
$28K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
508 |
443 |
$24K |
| A7000 |
Canister, disposable, used with suction pump, each |
2,078 |
1,544 |
$23K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
1,299 |
1,107 |
$22K |
| E0303 |
Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress |
229 |
192 |
$22K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
543 |
345 |
$21K |
| E0156 |
Seat attachment, walker |
2,181 |
1,964 |
$18K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
1,078 |
642 |
$18K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
267 |
244 |
$18K |
| A7002 |
Tubing, used with suction pump, each |
2,773 |
1,904 |
$16K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
177 |
146 |
$15K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
379 |
319 |
$14K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,910 |
1,615 |
$11K |
| A4554 |
Disposable underpads, all sizes |
531 |
397 |
$10K |
| A7509 |
Filter holder and integrated filter housing, and adhesive, for use as a tracheostoma heat and moisture exchange system, each |
290 |
207 |
$9K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
1,937 |
1,355 |
$9K |
| E0439 |
Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing |
115 |
98 |
$8K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
8,340 |
7,276 |
$8K |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
212 |
203 |
$8K |
| A6210 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
35 |
25 |
$7K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
46 |
42 |
$5K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,445 |
1,111 |
$5K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
465 |
303 |
$4K |
| L3260 |
Surgical boot/shoe, each |
547 |
467 |
$4K |
| L3807 |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
37 |
37 |
$4K |
| A7015 |
Aerosol mask, used with dme nebulizer |
2,361 |
2,121 |
$3K |
| L4386 |
Walking boot, non-pneumatic, 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 |
29 |
26 |
$2K |
| B9002 |
Enteral nutrition infusion pump, any type |
44 |
38 |
$2K |
| 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 |
$2K |
| A7036 |
Chinstrap used with positive airway pressure device |
208 |
186 |
$2K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
359 |
277 |
$2K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
202 |
169 |
$2K |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
2,581 |
1,946 |
$1K |
| E0434 |
Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing |
51 |
48 |
$1K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
66 |
61 |
$958.76 |
| K0003 |
Lightweight wheelchair |
43 |
36 |
$925.12 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
140 |
129 |
$762.20 |
| L0628 |
Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
17 |
15 |
$756.99 |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
27 |
27 |
$724.07 |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
12 |
12 |
$597.00 |
| A7525 |
Tracheostomy mask, each |
581 |
347 |
$541.81 |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
13 |
12 |
$414.40 |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
62 |
55 |
$412.69 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
98 |
82 |
$378.55 |
| E1399 |
Durable medical equipment, miscellaneous |
96 |
66 |
$330.68 |
| E0241 |
Bath tub wall rail, each |
14 |
14 |
$292.80 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
45 |
36 |
$207.51 |
| L0120 |
Cervical, flexible, non-adjustable, prefabricated, off-the-shelf (foam collar) |
12 |
12 |
$99.39 |
| A7012 |
Water collection device, used with large volume nebulizer |
32 |
24 |
$62.94 |
| K0052 |
Swingaway, detachable footrests, replacement only, each |
51 |
38 |
$42.00 |
| A4402 |
Lubricant, per ounce |
13 |
13 |
$25.10 |
| E1353 |
Regulator |
101 |
63 |
$16.91 |