| 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 |
3,757 |
3,401 |
$111K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,499 |
2,309 |
$23K |
| K0001 |
Standard wheelchair |
1,050 |
982 |
$21K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
827 |
743 |
$21K |
| E0601 |
Continuous positive airway pressure (cpap) device |
299 |
273 |
$6K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
1,415 |
638 |
$4K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
1,403 |
635 |
$2K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
164 |
136 |
$2K |
| E0570 |
Nebulizer, with compressor |
349 |
324 |
$2K |
| A7030 |
Full face mask used with positive airway pressure device, each |
71 |
63 |
$2K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
691 |
623 |
$1K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
1,084 |
489 |
$1K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
1,487 |
665 |
$939.13 |
| A7035 |
Headgear used with positive airway pressure device |
101 |
92 |
$628.81 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
252 |
221 |
$478.63 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
383 |
339 |
$465.50 |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
13 |
13 |
$365.69 |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
12 |
12 |
$353.57 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
14 |
14 |
$296.96 |
| A7031 |
Face mask interface, replacement for full face mask, each |
19 |
14 |
$99.84 |
| A7037 |
Tubing used with positive airway pressure device |
27 |
24 |
$65.04 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
16 |
12 |
$35.88 |