| 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 |
2,663 |
2,561 |
$141K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
676 |
658 |
$103K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,137 |
1,033 |
$76K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,458 |
1,328 |
$65K |
| E0570 |
Nebulizer, with compressor |
1,877 |
1,788 |
$46K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
715 |
705 |
$34K |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,781 |
1,693 |
$31K |
| A7030 |
Full face mask used with positive airway pressure device, each |
343 |
313 |
$24K |
| A7031 |
Face mask interface, replacement for full face mask, each |
838 |
810 |
$23K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
716 |
568 |
$19K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
796 |
749 |
$16K |
| K0001 |
Standard wheelchair |
505 |
428 |
$12K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
47 |
38 |
$10K |
| 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 |
194 |
125 |
$7K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,723 |
1,632 |
$6K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
352 |
317 |
$6K |
| A7035 |
Headgear used with positive airway pressure device |
363 |
332 |
$5K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
30 |
30 |
$4K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
280 |
238 |
$2K |
| 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 |
20 |
14 |
$757.57 |
| 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 |
22 |
14 |
$705.86 |
| A4927 |
Gloves, non-sterile, per 100 |
41 |
38 |
$549.49 |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
14 |
13 |
$287.48 |
| A7015 |
Aerosol mask, used with dme nebulizer |
27 |
27 |
$38.96 |