| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1220 |
Wheelchair; specially sized or constructed, (indicate brand name, model number, if any) and justification |
184 |
136 |
$1.06M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,524 |
1,587 |
$276K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
4,133 |
3,463 |
$214K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
455 |
144 |
$203K |
| B9998 |
Noc for enteral supplies |
3,939 |
1,571 |
$201K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
774 |
438 |
$77K |
| E0570 |
Nebulizer, with compressor |
3,694 |
2,935 |
$65K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,152 |
985 |
$40K |
| E0601 |
Continuous positive airway pressure (cpap) device |
805 |
716 |
$25K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
244 |
191 |
$22K |
| E1392 |
Portable oxygen concentrator, rental |
1,738 |
1,405 |
$20K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,148 |
866 |
$16K |
| K0001 |
Standard wheelchair |
1,013 |
852 |
$11K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
33 |
24 |
$11K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
1,451 |
695 |
$11K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
2,620 |
1,145 |
$10K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
425 |
346 |
$8K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
575 |
371 |
$7K |
| A4554 |
Disposable underpads, all sizes |
131 |
88 |
$6K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
103 |
101 |
$5K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
1,155 |
242 |
$5K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
23 |
16 |
$3K |
| A7037 |
Tubing used with positive airway pressure device |
473 |
252 |
$2K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
183 |
174 |
$2K |
| A7000 |
Canister, disposable, used with suction pump, each |
419 |
288 |
$2K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
163 |
96 |
$2K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
27 |
12 |
$2K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
33 |
24 |
$2K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
16 |
12 |
$1K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
777 |
215 |
$1K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
62 |
38 |
$1K |
| A4217 |
Sterile water/saline, 500 ml |
52 |
25 |
$1K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
64 |
52 |
$1K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
13 |
12 |
$937.08 |
| A7002 |
Tubing, used with suction pump, each |
508 |
297 |
$906.17 |
| A7526 |
Tracheostomy tube collar/holder, each |
27 |
12 |
$792.49 |
| A7035 |
Headgear used with positive airway pressure device |
41 |
26 |
$161.51 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
27 |
13 |
$120.69 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
81 |
70 |
$98.13 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
44 |
28 |
$59.50 |
| E0310 |
Bed side rails, full length |
30 |
24 |
$0.00 |