| 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 |
14,417 |
13,759 |
$688K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
1,725 |
760 |
$342K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
1,092 |
904 |
$203K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
1,693 |
1,061 |
$189K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
13,966 |
13,327 |
$185K |
| E1399 |
Durable medical equipment, miscellaneous |
201 |
133 |
$161K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
2,778 |
1,840 |
$138K |
| K0001 |
Standard wheelchair |
7,980 |
7,437 |
$116K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,124 |
819 |
$108K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,062 |
797 |
$95K |
| A7526 |
Tracheostomy tube collar/holder, each |
1,303 |
1,133 |
$85K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
763 |
654 |
$69K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
1,048 |
936 |
$61K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
1,067 |
874 |
$60K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
1,324 |
1,089 |
$58K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
1,267 |
1,003 |
$56K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
540 |
513 |
$55K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
734 |
442 |
$53K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
1,115 |
772 |
$53K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
2,247 |
2,081 |
$52K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,448 |
1,284 |
$50K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,773 |
1,623 |
$47K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
5,633 |
5,185 |
$46K |
| E0277 |
Powered pressure-reducing air mattress |
567 |
495 |
$45K |
| S8120 |
Oxygen contents, gaseous, 1 unit equals 1 cubic foot |
899 |
499 |
$41K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
1,057 |
1,014 |
$38K |
| A4623 |
Tracheostomy, inner cannula |
317 |
277 |
$36K |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
3,113 |
2,917 |
$30K |
| 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 |
1,468 |
1,266 |
$29K |
| K0040 |
Adjustable angle footplate, each |
454 |
294 |
$29K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
1,966 |
1,260 |
$27K |
| A7030 |
Full face mask used with positive airway pressure device, each |
386 |
365 |
$27K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
290 |
275 |
$27K |
| K0006 |
Heavy duty wheelchair |
690 |
627 |
$23K |
| K0003 |
Lightweight wheelchair |
834 |
781 |
$22K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
217 |
213 |
$19K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
286 |
239 |
$19K |
| E0251 |
Hospital bed, fixed height, with any type side rails, without mattress |
2,194 |
2,040 |
$18K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
1,143 |
854 |
$17K |
| E0570 |
Nebulizer, with compressor |
1,792 |
1,731 |
$17K |
| K0007 |
Extra heavy duty wheelchair |
308 |
267 |
$17K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,432 |
1,091 |
$17K |
| A4927 |
Gloves, non-sterile, per 100 |
1,159 |
982 |
$17K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,056 |
1,002 |
$16K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
627 |
595 |
$15K |
| E0601 |
Continuous positive airway pressure (cpap) device |
460 |
436 |
$14K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
674 |
599 |
$13K |
| A7002 |
Tubing, used with suction pump, each |
1,325 |
1,117 |
$12K |
| B9002 |
Enteral nutrition infusion pump, any type |
260 |
246 |
$12K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
453 |
407 |
$11K |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
241 |
221 |
$11K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
237 |
226 |
$10K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
770 |
670 |
$10K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
279 |
88 |
$8K |
| A4218 |
Sterile saline or water, metered dose dispenser, 10 ml |
112 |
108 |
$8K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
573 |
503 |
$7K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
45 |
30 |
$7K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
197 |
188 |
$7K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,765 |
1,672 |
$6K |
| K0825 |
Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds |
63 |
60 |
$5K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
871 |
547 |
$4K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
209 |
202 |
$4K |
| E2620 |
Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware |
21 |
12 |
$4K |
| A7525 |
Tracheostomy mask, each |
1,111 |
795 |
$4K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,471 |
999 |
$3K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
363 |
348 |
$3K |
| 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 |
64 |
50 |
$3K |
| E2361 |
Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
14 |
12 |
$3K |
| 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 |
50 |
48 |
$3K |
| A7035 |
Headgear used with positive airway pressure device |
207 |
196 |
$2K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
105 |
103 |
$2K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
127 |
83 |
$2K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
426 |
410 |
$2K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
98 |
87 |
$1K |
| E0184 |
Dry pressure mattress |
15 |
13 |
$1K |
| E2231 |
Manual wheelchair accessory, solid seat support base (replaces sling seat), includes any type mounting hardware |
18 |
12 |
$1K |
| B9998 |
Noc for enteral supplies |
16 |
12 |
$1K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
40 |
38 |
$1K |
| E1035 |
Multi-positional patient transfer system, with integrated seat, operated by care giver, patient weight capacity up to and including 300 lbs |
45 |
37 |
$799.41 |
| A7012 |
Water collection device, used with large volume nebulizer |
264 |
166 |
$782.40 |
| E0960 |
Wheelchair accessory, shoulder harness/straps or chest strap, including any type mounting hardware |
14 |
12 |
$752.60 |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
14 |
12 |
$705.60 |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
36 |
24 |
$550.99 |
| K0072 |
Front caster assembly, complete, with semi-pneumatic tire, replacement only, each |
17 |
13 |
$487.78 |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
28 |
25 |
$230.92 |
| K0002 |
Standard hemi (low seat) wheelchair |
12 |
12 |
$94.39 |
| A4245 |
Alcohol wipes, per box |
12 |
12 |
$29.62 |