| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A7030 |
Full face mask used with positive airway pressure device, each |
2,815 |
2,784 |
$129K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
1,449 |
831 |
$120K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,924 |
1,917 |
$64K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
1,499 |
1,435 |
$64K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,962 |
1,946 |
$62K |
| A7031 |
Face mask interface, replacement for full face mask, each |
2,352 |
2,123 |
$59K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
729 |
728 |
$45K |
| A7037 |
Tubing used with positive airway pressure device |
2,859 |
2,834 |
$42K |
| A7035 |
Headgear used with positive airway pressure device |
3,026 |
3,002 |
$35K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
187 |
185 |
$24K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
719 |
606 |
$21K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
4,521 |
4,350 |
$20K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
218 |
218 |
$16K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
877 |
877 |
$9K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
446 |
380 |
$9K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,962 |
1,954 |
$8K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
162 |
79 |
$6K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
26 |
26 |
$5K |
| E0570 |
Nebulizer, with compressor |
162 |
159 |
$4K |
| K0462 |
Temporary replacement for patient owned equipment being repaired, any type |
130 |
122 |
$3K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
67 |
51 |
$2K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
29 |
26 |
$2K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
12 |
12 |
$1K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
12 |
12 |
$530.51 |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
24 |
24 |
$433.14 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
14 |
12 |
$171.21 |