| 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 |
4,729 |
4,445 |
$483K |
| E0601 |
Continuous positive airway pressure (cpap) device |
3,658 |
3,453 |
$247K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,212 |
2,034 |
$159K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,391 |
1,315 |
$145K |
| T4541 |
Incontinence product, disposable underpad, large, each |
3,396 |
3,194 |
$139K |
| E0570 |
Nebulizer, with compressor |
1,502 |
1,446 |
$138K |
| 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 |
748 |
657 |
$103K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
857 |
803 |
$103K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
783 |
723 |
$73K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
3,572 |
3,352 |
$73K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
652 |
594 |
$73K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,679 |
1,563 |
$67K |
| K0001 |
Standard wheelchair |
2,536 |
2,335 |
$66K |
| A7030 |
Full face mask used with positive airway pressure device, each |
368 |
344 |
$51K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
538 |
492 |
$50K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
662 |
621 |
$35K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
486 |
458 |
$31K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,329 |
1,275 |
$31K |
| A7035 |
Headgear used with positive airway pressure device |
901 |
846 |
$26K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
382 |
347 |
$22K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
1,075 |
987 |
$17K |
| A7031 |
Face mask interface, replacement for full face mask, each |
294 |
285 |
$16K |
| 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 |
94 |
74 |
$14K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,415 |
1,358 |
$11K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
60 |
53 |
$11K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
849 |
777 |
$11K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
173 |
144 |
$11K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
54 |
52 |
$8K |
| A4927 |
Gloves, non-sterile, per 100 |
705 |
656 |
$8K |
| 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 |
26 |
25 |
$8K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
17 |
14 |
$3K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
418 |
349 |
$3K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
381 |
367 |
$3K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
30 |
29 |
$3K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
13 |
13 |
$2K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
69 |
64 |
$1K |
| A7015 |
Aerosol mask, used with dme nebulizer |
427 |
413 |
$699.59 |
| E0156 |
Seat attachment, walker |
13 |
13 |
$232.81 |
| A4217 |
Sterile water/saline, 500 ml |
13 |
12 |
$154.23 |
| A5120 |
Skin barrier, wipes or swabs, each |
12 |
12 |
$133.00 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
39 |
38 |
$129.48 |