| 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 |
15,594 |
15,499 |
$1.12M |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
4,062 |
4,060 |
$741K |
| E1399 |
Durable medical equipment, miscellaneous |
7,892 |
6,010 |
$296K |
| E0570 |
Nebulizer, with compressor |
4,073 |
4,061 |
$191K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
8,540 |
8,513 |
$131K |
| K0001 |
Standard wheelchair |
3,719 |
3,664 |
$81K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
1,307 |
1,301 |
$78K |
| E0265 |
Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress |
963 |
959 |
$75K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,267 |
1,264 |
$73K |
| E1392 |
Portable oxygen concentrator, rental |
3,734 |
3,709 |
$69K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,944 |
1,929 |
$64K |
| E0601 |
Continuous positive airway pressure (cpap) device |
807 |
797 |
$46K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
394 |
389 |
$21K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
813 |
796 |
$14K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
1,199 |
1,186 |
$8K |
| 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 |
171 |
171 |
$8K |
| K0003 |
Lightweight wheelchair |
230 |
230 |
$7K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
1,094 |
1,071 |
$6K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
289 |
282 |
$4K |
| E0271 |
Mattress, innerspring |
207 |
207 |
$4K |
| 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 |
98 |
98 |
$3K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
66 |
66 |
$3K |
| E0277 |
Powered pressure-reducing air mattress |
13 |
13 |
$3K |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
291 |
291 |
$3K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
972 |
923 |
$3K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
166 |
166 |
$2K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
153 |
153 |
$2K |
| 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 |
61 |
61 |
$2K |
| K0002 |
Standard hemi (low seat) wheelchair |
69 |
68 |
$2K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
480 |
379 |
$2K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
68 |
68 |
$2K |
| T4541 |
Incontinence product, disposable underpad, large, each |
63 |
63 |
$1K |
| 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) |
13 |
13 |
$1K |
| A4258 |
Spring-powered device for lancet, each |
144 |
144 |
$777.50 |
| A7030 |
Full face mask used with positive airway pressure device, each |
12 |
12 |
$774.46 |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
50 |
50 |
$748.76 |
| A7035 |
Headgear used with positive airway pressure device |
42 |
42 |
$662.00 |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
25 |
25 |
$613.84 |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
29 |
29 |
$432.13 |
| A4245 |
Alcohol wipes, per box |
151 |
151 |
$185.03 |
| A7037 |
Tubing used with positive airway pressure device |
13 |
13 |
$157.97 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
25 |
25 |
$115.81 |