| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
558 |
495 |
$141K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
1,308 |
1,247 |
$101K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,725 |
1,633 |
$70K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,056 |
1,033 |
$47K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,112 |
1,090 |
$46K |
| A7030 |
Full face mask used with positive airway pressure device, each |
426 |
420 |
$43K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
460 |
386 |
$40K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
657 |
580 |
$38K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
647 |
556 |
$36K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
576 |
561 |
$36K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
488 |
421 |
$35K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
719 |
701 |
$31K |
| A7035 |
Headgear used with positive airway pressure device |
1,343 |
1,301 |
$28K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
589 |
543 |
$28K |
| E1392 |
Portable oxygen concentrator, rental |
754 |
720 |
$24K |
| E0570 |
Nebulizer, with compressor |
482 |
474 |
$19K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,701 |
2,657 |
$15K |
| K0001 |
Standard wheelchair |
663 |
620 |
$14K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
352 |
344 |
$12K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
465 |
460 |
$6K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
27 |
25 |
$6K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
31 |
30 |
$5K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
37 |
36 |
$2K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
79 |
73 |
$1K |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
12 |
12 |
$764.86 |