| 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 |
11,619 |
11,618 |
$947K |
| E0570 |
Nebulizer, with compressor |
3,050 |
3,048 |
$419K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
1,201 |
1,201 |
$337K |
| E1399 |
Durable medical equipment, miscellaneous |
2,377 |
2,031 |
$213K |
| K0003 |
Lightweight wheelchair |
5,594 |
5,587 |
$200K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
8,970 |
8,970 |
$141K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
3,334 |
3,333 |
$140K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
2,191 |
2,180 |
$93K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
420 |
419 |
$45K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
1,458 |
1,353 |
$43K |
| E0245 |
Tub stool or bench |
1,032 |
1,031 |
$37K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,754 |
1,754 |
$34K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
1,148 |
1,094 |
$31K |
| A4670 |
Automatic blood pressure monitor |
314 |
314 |
$31K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
2,815 |
2,772 |
$24K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
385 |
216 |
$22K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
2,853 |
2,852 |
$17K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
191 |
175 |
$16K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
680 |
680 |
$16K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
2,121 |
2,121 |
$14K |
| A7030 |
Full face mask used with positive airway pressure device, each |
333 |
332 |
$13K |
| E0156 |
Seat attachment, walker |
1,320 |
1,320 |
$12K |
| 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 |
130 |
90 |
$11K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
632 |
632 |
$10K |
| A7035 |
Headgear used with positive airway pressure device |
1,038 |
1,036 |
$8K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
68 |
68 |
$7K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
149 |
149 |
$6K |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
12 |
12 |
$6K |
| K0822 |
Power wheelchair, group 2 standard, sling/solid seat/back, patient weight capacity up to and including 300 pounds |
41 |
41 |
$5K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
648 |
630 |
$5K |
| 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 |
41 |
27 |
$5K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,776 |
1,763 |
$4K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
345 |
328 |
$3K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
228 |
127 |
$3K |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
25 |
25 |
$2K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,257 |
1,254 |
$2K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
38 |
38 |
$2K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
29 |
29 |
$2K |
| A4452 |
Tape, waterproof, per 18 square inches |
80 |
79 |
$2K |
| K0006 |
Heavy duty wheelchair |
39 |
39 |
$2K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
304 |
304 |
$1K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
359 |
349 |
$1K |
| A4456 |
Adhesive remover, wipes, any type, each |
75 |
75 |
$880.74 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
200 |
200 |
$859.86 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
51 |
50 |
$752.65 |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
12 |
12 |
$745.69 |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
12 |
12 |
$469.75 |
| A5120 |
Skin barrier, wipes or swabs, each |
40 |
39 |
$436.39 |
| E0244 |
Raised toilet seat |
13 |
12 |
$370.97 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
62 |
52 |
$366.59 |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
30 |
30 |
$340.51 |
| K0053 |
Elevating footrests, articulating (telescoping), each |
26 |
26 |
$324.18 |
| A7037 |
Tubing used with positive airway pressure device |
12 |
12 |
$68.64 |