| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
4,132 |
3,937 |
$935K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
2,456 |
2,397 |
$552K |
| A7030 |
Full face mask used with positive airway pressure device, each |
4,096 |
3,871 |
$522K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
5,345 |
4,995 |
$480K |
| E0601 |
Continuous positive airway pressure (cpap) device |
6,440 |
6,159 |
$477K |
| A7031 |
Face mask interface, replacement for full face mask, each |
3,672 |
3,476 |
$426K |
| L1833 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
997 |
928 |
$328K |
| E0570 |
Nebulizer, with compressor |
3,732 |
3,489 |
$257K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
4,475 |
3,800 |
$224K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
2,295 |
2,186 |
$179K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
7,723 |
7,409 |
$173K |
| E0470 |
Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
1,075 |
1,036 |
$159K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
1,734 |
1,618 |
$128K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
1,854 |
1,764 |
$120K |
| A7037 |
Tubing used with positive airway pressure device |
4,424 |
4,150 |
$108K |
| L3660 |
Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf |
1,377 |
1,325 |
$106K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
961 |
920 |
$104K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
6,055 |
5,743 |
$104K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
808 |
767 |
$101K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
2,061 |
2,003 |
$98K |
| A7035 |
Headgear used with positive airway pressure device |
3,804 |
3,601 |
$89K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,314 |
1,273 |
$77K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
466 |
461 |
$75K |
| 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 |
3,614 |
3,358 |
$74K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
1,874 |
1,814 |
$73K |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
464 |
451 |
$61K |
| L1812 |
Knee orthosis, elastic with joints, prefabricated, off-the-shelf |
876 |
837 |
$61K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
866 |
822 |
$54K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
409 |
380 |
$49K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
278 |
271 |
$38K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
2,793 |
2,658 |
$35K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,491 |
1,396 |
$35K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
180 |
164 |
$23K |
| E1392 |
Portable oxygen concentrator, rental |
1,275 |
1,200 |
$21K |
| K0001 |
Standard wheelchair |
616 |
539 |
$16K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
812 |
783 |
$16K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
274 |
241 |
$15K |
| E1399 |
Durable medical equipment, miscellaneous |
36 |
12 |
$13K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
221 |
214 |
$11K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
65 |
63 |
$9K |
| K0004 |
High strength, lightweight wheelchair |
109 |
100 |
$8K |
| K0002 |
Standard hemi (low seat) wheelchair |
204 |
187 |
$7K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
320 |
294 |
$7K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
43 |
38 |
$6K |
| A4670 |
Automatic blood pressure monitor |
67 |
67 |
$6K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
764 |
659 |
$5K |
| T4541 |
Incontinence product, disposable underpad, large, each |
123 |
117 |
$5K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
52 |
50 |
$5K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
137 |
133 |
$5K |
| L3984 |
Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and adjustment |
29 |
28 |
$4K |
| E0156 |
Seat attachment, walker |
446 |
423 |
$3K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
387 |
356 |
$3K |
| A4927 |
Gloves, non-sterile, per 100 |
166 |
156 |
$2K |
| 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 |
15 |
14 |
$2K |
| L3924 |
Hand finger orthosis, without joints, may include soft interface, straps, prefabricated, off-the-shelf |
29 |
24 |
$2K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
17 |
15 |
$817.96 |
| A7015 |
Aerosol mask, used with dme nebulizer |
564 |
532 |
$769.79 |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
15 |
12 |
$648.01 |
| E0240 |
Bath/shower chair, with or without wheels, any size |
12 |
12 |
$506.72 |
| A4554 |
Disposable underpads, all sizes |
19 |
18 |
$391.00 |
| K0003 |
Lightweight wheelchair |
13 |
13 |
$379.52 |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
19 |
15 |
$286.08 |
| A7036 |
Chinstrap used with positive airway pressure device |
27 |
27 |
$280.83 |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
12 |
12 |
$63.63 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
36 |
36 |
$10.72 |