| 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 |
3,520 |
3,061 |
$198K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,731 |
1,600 |
$96K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
1,805 |
1,000 |
$45K |
| E0570 |
Nebulizer, with compressor |
2,013 |
1,752 |
$41K |
| K0001 |
Standard wheelchair |
3,235 |
2,683 |
$32K |
| A7030 |
Full face mask used with positive airway pressure device, each |
349 |
315 |
$29K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
700 |
589 |
$19K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
1,797 |
995 |
$18K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
346 |
324 |
$12K |
| L1832 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
40 |
38 |
$12K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,743 |
1,509 |
$9K |
| A7037 |
Tubing used with positive airway pressure device |
316 |
287 |
$7K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
52 |
49 |
$2K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
315 |
251 |
$2K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
1,169 |
376 |
$985.09 |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
45 |
29 |
$966.91 |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
17 |
17 |
$615.35 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
192 |
175 |
$274.86 |
| A7035 |
Headgear used with positive airway pressure device |
14 |
14 |
$244.56 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
12 |
12 |
$199.72 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
13 |
13 |
$116.95 |
| A4452 |
Tape, waterproof, per 18 square inches |
15 |
14 |
$70.28 |