| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
2,785 |
1,886 |
$409K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
2,544 |
2,499 |
$376K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,891 |
2,753 |
$343K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
4,369 |
3,908 |
$282K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,320 |
2,224 |
$242K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,441 |
2,322 |
$210K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,943 |
2,820 |
$147K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
696 |
678 |
$131K |
| A4927 |
Gloves, non-sterile, per 100 |
2,414 |
2,362 |
$86K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,051 |
1,894 |
$78K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
178 |
167 |
$73K |
| A7030 |
Full face mask used with positive airway pressure device, each |
646 |
601 |
$56K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,436 |
1,356 |
$54K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
785 |
755 |
$48K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,456 |
1,346 |
$47K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
948 |
620 |
$45K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
323 |
186 |
$42K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,579 |
2,413 |
$40K |
| K0001 |
Standard wheelchair |
806 |
779 |
$28K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
296 |
209 |
$26K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
525 |
459 |
$25K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
133 |
131 |
$18K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
395 |
383 |
$15K |
| A7035 |
Headgear used with positive airway pressure device |
852 |
763 |
$15K |
| E0570 |
Nebulizer, with compressor |
794 |
768 |
$14K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,179 |
3,041 |
$14K |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
476 |
468 |
$13K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
51 |
51 |
$11K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
213 |
154 |
$10K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
274 |
263 |
$9K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
69 |
67 |
$8K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
357 |
348 |
$5K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
198 |
186 |
$5K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
44 |
44 |
$3K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
12 |
12 |
$3K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
351 |
306 |
$3K |
| K0040 |
Adjustable angle footplate, each |
15 |
12 |
$1K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
25 |
24 |
$652.29 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
71 |
68 |
$521.38 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
15 |
15 |
$62.36 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
67 |
64 |
$53.43 |