| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6549 |
Gradient compression garment, not otherwise specified, for daytime use, each |
2,791 |
841 |
$556K |
| E0601 |
Continuous positive airway pressure (cpap) device |
4,002 |
3,915 |
$432K |
| S9999 |
Sales tax |
14,634 |
13,234 |
$264K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,572 |
1,529 |
$197K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,148 |
1,133 |
$157K |
| E0570 |
Nebulizer, with compressor |
3,407 |
3,280 |
$141K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
2,906 |
2,863 |
$140K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,558 |
1,535 |
$135K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
1,822 |
1,816 |
$88K |
| A7035 |
Headgear used with positive airway pressure device |
3,005 |
2,953 |
$87K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,850 |
1,820 |
$84K |
| K0001 |
Standard wheelchair |
3,140 |
3,069 |
$72K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
450 |
428 |
$69K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
4,453 |
4,370 |
$36K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
920 |
900 |
$35K |
| A7037 |
Tubing used with positive airway pressure device |
1,001 |
991 |
$30K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
864 |
833 |
$21K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
963 |
947 |
$14K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
287 |
277 |
$13K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
969 |
956 |
$11K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
767 |
719 |
$10K |
| A7031 |
Face mask interface, replacement for full face mask, each |
240 |
234 |
$9K |
| 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) |
25 |
25 |
$8K |
| A4927 |
Gloves, non-sterile, per 100 |
817 |
766 |
$8K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,016 |
958 |
$8K |
| E0294 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress |
92 |
92 |
$7K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
188 |
184 |
$5K |
| A4452 |
Tape, waterproof, per 18 square inches |
202 |
195 |
$5K |
| T4541 |
Incontinence product, disposable underpad, large, each |
81 |
76 |
$3K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
834 |
776 |
$3K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
65 |
60 |
$2K |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
26 |
26 |
$2K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
12 |
12 |
$1K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
38 |
38 |
$888.59 |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
14 |
12 |
$579.04 |
| E0156 |
Seat attachment, walker |
37 |
37 |
$367.94 |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
12 |
12 |
$358.76 |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
13 |
13 |
$222.46 |