| 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 |
702 |
601 |
$32K |
| E0601 |
Continuous positive airway pressure (cpap) device |
443 |
415 |
$14K |
| 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) |
140 |
140 |
$10K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
528 |
448 |
$9K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
66 |
51 |
$5K |
| E0570 |
Nebulizer, with compressor |
267 |
234 |
$5K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
198 |
192 |
$4K |
| K0001 |
Standard wheelchair |
211 |
198 |
$3K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
30 |
29 |
$3K |
| A4927 |
Gloves, non-sterile, per 100 |
220 |
178 |
$2K |
| A7035 |
Headgear used with positive airway pressure device |
142 |
133 |
$2K |
| A7030 |
Full face mask used with positive airway pressure device, each |
28 |
27 |
$2K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
18 |
13 |
$791.74 |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
43 |
42 |
$750.50 |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
13 |
12 |
$718.83 |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
14 |
13 |
$500.15 |
| A4452 |
Tape, waterproof, per 18 square inches |
15 |
13 |
$419.20 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
173 |
140 |
$321.07 |
| A7037 |
Tubing used with positive airway pressure device |
13 |
12 |
$221.40 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
61 |
54 |
$95.12 |
| A4554 |
Disposable underpads, all sizes |
43 |
39 |
$0.00 |