| 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 |
420 |
331 |
$12K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
38 |
18 |
$4K |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
231 |
185 |
$1K |
| E0570 |
Nebulizer, with compressor |
48 |
44 |
$673.92 |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
21 |
17 |
$671.99 |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
42 |
36 |
$440.19 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
22 |
14 |
$283.97 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
18 |
14 |
$225.28 |
| E0601 |
Continuous positive airway pressure (cpap) device |
20 |
18 |
$223.72 |
| A7000 |
Canister, disposable, used with suction pump, each |
17 |
13 |
$128.42 |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
21 |
19 |
$75.12 |
| K0001 |
Standard wheelchair |
22 |
15 |
$69.33 |
| A7002 |
Tubing, used with suction pump, each |
18 |
13 |
$67.30 |
| B9998 |
Noc for enteral supplies |
24 |
12 |
$66.82 |