| 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 |
15,652 |
12,440 |
$1.01M |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,058 |
1,548 |
$118K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
10,509 |
8,083 |
$99K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,432 |
1,990 |
$98K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
879 |
789 |
$77K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
2,081 |
1,375 |
$55K |
| 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) |
671 |
505 |
$51K |
| K0001 |
Standard wheelchair |
3,053 |
2,029 |
$46K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,901 |
1,512 |
$43K |
| A4927 |
Gloves, non-sterile, per 100 |
3,296 |
2,236 |
$41K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,213 |
1,869 |
$40K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,728 |
1,278 |
$39K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
2,357 |
1,905 |
$38K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
468 |
399 |
$37K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
457 |
426 |
$30K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
294 |
261 |
$26K |
| A7035 |
Headgear used with positive airway pressure device |
1,755 |
1,380 |
$24K |
| E0570 |
Nebulizer, with compressor |
3,529 |
2,454 |
$18K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,596 |
2,834 |
$16K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
132 |
108 |
$15K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
287 |
222 |
$12K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
100 |
84 |
$9K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
619 |
468 |
$7K |
| A4670 |
Automatic blood pressure monitor |
123 |
114 |
$6K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
919 |
712 |
$5K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
459 |
357 |
$3K |
| A7037 |
Tubing used with positive airway pressure device |
91 |
65 |
$899.94 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
29 |
29 |
$669.69 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
14 |
12 |
$606.36 |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
13 |
12 |
$327.78 |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
16 |
13 |
$236.86 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
18 |
12 |
$132.61 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
30 |
30 |
$78.14 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
1,306 |
738 |
$0.00 |