| 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 |
7,830 |
7,175 |
$597K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
3,322 |
3,014 |
$338K |
| E0570 |
Nebulizer, with compressor |
3,847 |
3,472 |
$153K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
3,875 |
3,551 |
$65K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
2,333 |
2,105 |
$62K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,427 |
1,183 |
$50K |
| K0001 |
Standard wheelchair |
3,555 |
3,216 |
$47K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,300 |
1,219 |
$27K |
| A4554 |
Disposable underpads, all sizes |
1,114 |
1,000 |
$27K |
| A7030 |
Full face mask used with positive airway pressure device, each |
251 |
229 |
$15K |
| A7035 |
Headgear used with positive airway pressure device |
529 |
475 |
$12K |
| A7037 |
Tubing used with positive airway pressure device |
548 |
497 |
$12K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,043 |
942 |
$11K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
154 |
84 |
$5K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
4,481 |
1,897 |
$5K |
| 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) |
65 |
65 |
$5K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
145 |
129 |
$4K |
| E0245 |
Tub stool or bench |
38 |
37 |
$4K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
26 |
24 |
$3K |
| A7015 |
Aerosol mask, used with dme nebulizer |
674 |
612 |
$3K |
| A5513 |
For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
27 |
25 |
$3K |
| 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 |
26 |
25 |
$3K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
49 |
34 |
$3K |
| K0800 |
Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds |
84 |
72 |
$3K |
| K0007 |
Extra heavy duty wheelchair |
41 |
37 |
$3K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
102 |
92 |
$2K |
| E0303 |
Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress |
29 |
25 |
$1K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
14 |
13 |
$520.34 |
| E0156 |
Seat attachment, walker |
64 |
51 |
$353.98 |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
13 |
12 |
$167.49 |