| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L2630 |
Addition to lower extremity, pelvic control, band and belt, unilateral |
1,719 |
1,340 |
$359K |
| A4287 |
Disposable collection and storage bag for breast milk, any size, any type, each |
7,938 |
7,904 |
$302K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
2,431 |
1,987 |
$272K |
| E0601 |
Continuous positive airway pressure (cpap) device |
5,516 |
4,557 |
$229K |
| K1005 |
Disposable collection and storage bag for breast milk, any size, any type, each |
5,091 |
5,088 |
$194K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
1,835 |
1,612 |
$156K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,432 |
1,141 |
$116K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
1,706 |
1,356 |
$113K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,349 |
1,097 |
$107K |
| 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 |
1,395 |
1,142 |
$93K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
2,578 |
2,054 |
$63K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
991 |
799 |
$47K |
| A7035 |
Headgear used with positive airway pressure device |
2,028 |
1,695 |
$40K |
| 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) |
246 |
239 |
$33K |
| K0001 |
Standard wheelchair |
1,411 |
1,116 |
$26K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
510 |
443 |
$23K |
| A7031 |
Face mask interface, replacement for full face mask, each |
650 |
505 |
$22K |
| E0570 |
Nebulizer, with compressor |
886 |
616 |
$22K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,377 |
2,781 |
$18K |
| E1392 |
Portable oxygen concentrator, rental |
792 |
702 |
$16K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,202 |
1,014 |
$13K |
| L0625 |
Lumbar orthosis, flexible, provides lumbar support, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include pendulous abdomen design, shoulder straps, stays, prefabricated, off-the-shelf |
272 |
223 |
$9K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
1,290 |
1,034 |
$9K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
152 |
149 |
$8K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
116 |
100 |
$2K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
58 |
38 |
$2K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
12 |
12 |
$430.63 |
| A7037 |
Tubing used with positive airway pressure device |
13 |
13 |
$82.38 |