| 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 |
3,332 |
3,315 |
$386K |
| E0570 |
Nebulizer, with compressor |
2,465 |
2,450 |
$236K |
| T4541 |
Incontinence product, disposable underpad, large, each |
6,260 |
6,192 |
$235K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
1,016 |
401 |
$168K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
3,235 |
3,202 |
$155K |
| K0001 |
Standard wheelchair |
2,031 |
1,993 |
$151K |
| A4670 |
Automatic blood pressure monitor |
1,274 |
1,271 |
$133K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,802 |
1,773 |
$117K |
| E0601 |
Continuous positive airway pressure (cpap) device |
947 |
926 |
$112K |
| E0295 |
Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress |
611 |
601 |
$102K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,563 |
1,553 |
$95K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
629 |
611 |
$94K |
| K0003 |
Lightweight wheelchair |
605 |
591 |
$73K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,502 |
1,493 |
$71K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
3,403 |
3,357 |
$70K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,169 |
1,155 |
$68K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,016 |
1,010 |
$66K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,075 |
1,066 |
$62K |
| E0720 |
Transcutaneous electrical nerve stimulation (tens) device, two lead, localized stimulation |
447 |
447 |
$54K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
742 |
679 |
$54K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
835 |
823 |
$53K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,032 |
1,009 |
$46K |
| E0245 |
Tub stool or bench |
609 |
606 |
$30K |
| A6545 |
Gradient compression wrap, non-elastic, below knee, 30-50 mmhg, used as a surgical dressing, each |
284 |
206 |
$23K |
| A4335 |
Incontinence supply; miscellaneous |
2,447 |
2,408 |
$21K |
| 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 |
248 |
215 |
$20K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
1,812 |
1,788 |
$19K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
352 |
334 |
$18K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
217 |
213 |
$17K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
732 |
721 |
$17K |
| E0156 |
Seat attachment, walker |
826 |
824 |
$13K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
265 |
263 |
$13K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
175 |
169 |
$12K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
262 |
257 |
$11K |
| E0277 |
Powered pressure-reducing air mattress |
37 |
37 |
$10K |
| A4927 |
Gloves, non-sterile, per 100 |
1,334 |
1,325 |
$8K |
| 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 |
203 |
119 |
$7K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
228 |
227 |
$6K |
| L0621 |
Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf |
63 |
63 |
$4K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
103 |
103 |
$4K |
| A7037 |
Tubing used with positive airway pressure device |
218 |
217 |
$4K |
| L4360 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
40 |
40 |
$4K |
| A7035 |
Headgear used with positive airway pressure device |
154 |
153 |
$3K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
131 |
131 |
$2K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
26 |
26 |
$2K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
222 |
219 |
$2K |
| E2395 |
Power wheelchair accessory, caster wheel excludes tire, any size, replacement only, each |
13 |
12 |
$2K |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
94 |
94 |
$2K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
121 |
121 |
$1K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
13 |
13 |
$945.05 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
57 |
57 |
$475.85 |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
12 |
12 |
$285.40 |
| A7015 |
Aerosol mask, used with dme nebulizer |
62 |
62 |
$62.71 |