| 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 |
4,241 |
3,952 |
$156K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
627 |
531 |
$85K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,297 |
1,243 |
$83K |
| E0601 |
Continuous positive airway pressure (cpap) device |
3,220 |
3,004 |
$77K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
582 |
519 |
$73K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,452 |
1,381 |
$64K |
| A7031 |
Face mask interface, replacement for full face mask, each |
2,075 |
1,913 |
$62K |
| E0570 |
Nebulizer, with compressor |
879 |
855 |
$50K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
402 |
337 |
$46K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
735 |
684 |
$42K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,022 |
898 |
$26K |
| T4541 |
Incontinence product, disposable underpad, large, each |
399 |
359 |
$25K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
756 |
748 |
$24K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
582 |
543 |
$22K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,084 |
1,946 |
$20K |
| A7035 |
Headgear used with positive airway pressure device |
1,073 |
1,008 |
$15K |
| A4927 |
Gloves, non-sterile, per 100 |
516 |
454 |
$15K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,279 |
3,074 |
$13K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
131 |
126 |
$12K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
667 |
626 |
$8K |
| A7037 |
Tubing used with positive airway pressure device |
368 |
358 |
$4K |
| 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 |
50 |
36 |
$4K |
| A4335 |
Incontinence supply; miscellaneous |
1,040 |
942 |
$4K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
159 |
141 |
$3K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
12 |
12 |
$1K |
| K0003 |
Lightweight wheelchair |
46 |
42 |
$1K |
| 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) |
12 |
12 |
$797.12 |
| E1392 |
Portable oxygen concentrator, rental |
39 |
36 |
$519.05 |
| A7015 |
Aerosol mask, used with dme nebulizer |
164 |
162 |
$262.79 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
14 |
14 |
$172.71 |