| 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 |
14,129 |
13,436 |
$604K |
| A7030 |
Full face mask used with positive airway pressure device, each |
3,524 |
3,425 |
$229K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,786 |
1,720 |
$178K |
| E0601 |
Continuous positive airway pressure (cpap) device |
3,649 |
3,456 |
$105K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,005 |
943 |
$101K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,194 |
1,142 |
$95K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
4,516 |
4,406 |
$94K |
| A7031 |
Face mask interface, replacement for full face mask, each |
3,993 |
3,830 |
$92K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,136 |
2,028 |
$83K |
| E0439 |
Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing |
2,944 |
2,778 |
$74K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
7,563 |
7,192 |
$56K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
910 |
863 |
$52K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,091 |
1,075 |
$50K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
371 |
371 |
$50K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,140 |
2,039 |
$36K |
| 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) |
675 |
645 |
$35K |
| E0570 |
Nebulizer, with compressor |
4,434 |
4,198 |
$35K |
| A7035 |
Headgear used with positive airway pressure device |
2,982 |
2,922 |
$33K |
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
695 |
503 |
$33K |
| K0001 |
Standard wheelchair |
2,871 |
2,690 |
$32K |
| A4927 |
Gloves, non-sterile, per 100 |
3,097 |
2,911 |
$27K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
1,795 |
1,040 |
$27K |
| E1392 |
Portable oxygen concentrator, rental |
2,672 |
2,529 |
$27K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
706 |
688 |
$25K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,232 |
1,160 |
$21K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
518 |
501 |
$17K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
6,200 |
6,004 |
$17K |
| E0434 |
Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing |
2,585 |
2,468 |
$16K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
2,019 |
1,972 |
$12K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
700 |
673 |
$11K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
589 |
570 |
$9K |
| S5161 |
Emergency response system; service fee, per month (excludes installation and testing) |
350 |
312 |
$9K |
| E0442 |
Stationary oxygen contents, liquid, 1 month's supply = 1 unit |
595 |
575 |
$8K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
107 |
104 |
$8K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
45 |
27 |
$7K |
| A7000 |
Canister, disposable, used with suction pump, each |
378 |
360 |
$6K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
69 |
66 |
$5K |
| E0118 |
Crutch substitute, lower leg platform, with or without wheels, each |
281 |
281 |
$5K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
163 |
150 |
$5K |
| E0444 |
Portable oxygen contents, liquid, 1 month's supply = 1 unit |
227 |
217 |
$5K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
265 |
165 |
$4K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
13 |
13 |
$4K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
120 |
118 |
$4K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
25 |
25 |
$4K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
367 |
354 |
$3K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
46 |
45 |
$3K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
175 |
148 |
$3K |
| A7002 |
Tubing, used with suction pump, each |
345 |
325 |
$3K |
| A4217 |
Sterile water/saline, 500 ml |
18 |
14 |
$3K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
586 |
565 |
$2K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
295 |
253 |
$2K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
28 |
24 |
$2K |
| A4456 |
Adhesive remover, wipes, any type, each |
235 |
216 |
$2K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
28 |
14 |
$1K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
12 |
12 |
$1K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
38 |
37 |
$1K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
770 |
743 |
$992.56 |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
16 |
15 |
$835.94 |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
79 |
38 |
$603.00 |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
12 |
12 |
$387.81 |
| A5120 |
Skin barrier, wipes or swabs, each |
64 |
55 |
$387.33 |
| E0156 |
Seat attachment, walker |
45 |
39 |
$196.83 |
| A7015 |
Aerosol mask, used with dme nebulizer |
101 |
99 |
$129.79 |
| A7037 |
Tubing used with positive airway pressure device |
12 |
12 |
$112.07 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
12 |
12 |
$98.36 |