| 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 |
20,880 |
18,087 |
$561K |
| T4541 |
Incontinence product, disposable underpad, large, each |
4,836 |
4,543 |
$184K |
| K0001 |
Standard wheelchair |
23,443 |
20,094 |
$146K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
17,744 |
15,420 |
$104K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
7,609 |
6,456 |
$101K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,286 |
1,225 |
$85K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,010 |
957 |
$83K |
| E0250 |
Hospital bed, fixed height, with any type side rails, with mattress |
6,794 |
5,849 |
$81K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
1,111 |
930 |
$77K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,160 |
1,132 |
$75K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,027 |
966 |
$73K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
5,180 |
4,414 |
$66K |
| K0816 |
Power wheelchair, group 1 standard, captains chair, patient weight capacity up to and including 300 pounds |
1,530 |
1,304 |
$58K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
608 |
581 |
$52K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
239 |
225 |
$40K |
| E0185 |
Gel or gel-like pressure pad for mattress, standard mattress length and width |
1,118 |
970 |
$40K |
| E0277 |
Powered pressure-reducing air mattress |
378 |
316 |
$38K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
336 |
321 |
$37K |
| K0006 |
Heavy duty wheelchair |
1,864 |
1,599 |
$36K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
2,421 |
2,059 |
$35K |
| K0007 |
Extra heavy duty wheelchair |
979 |
849 |
$32K |
| K0003 |
Lightweight wheelchair |
2,732 |
2,286 |
$31K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
8,866 |
7,603 |
$28K |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
2,385 |
2,004 |
$27K |
| E0570 |
Nebulizer, with compressor |
6,113 |
5,276 |
$23K |
| A4927 |
Gloves, non-sterile, per 100 |
3,595 |
2,534 |
$17K |
| E0255 |
Hospital bed, variable height, hi-lo, with any type side rails, with mattress |
1,559 |
1,335 |
$17K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
176 |
166 |
$15K |
| A4623 |
Tracheostomy, inner cannula |
266 |
226 |
$14K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
712 |
581 |
$9K |
| E0156 |
Seat attachment, walker |
1,390 |
1,156 |
$5K |
| E0910 |
Trapeze bars, a/k/a patient helper, attached to bed, with grab bar |
1,872 |
1,643 |
$5K |
| K0825 |
Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity 301 to 450 pounds |
30 |
24 |
$4K |
| E1225 |
Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each |
574 |
478 |
$4K |
| K0002 |
Standard hemi (low seat) wheelchair |
345 |
285 |
$4K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
118 |
97 |
$4K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
52 |
50 |
$2K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
2,335 |
1,897 |
$2K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
410 |
336 |
$2K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
352 |
312 |
$1K |
| K0800 |
Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds |
130 |
115 |
$1K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
205 |
175 |
$1K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
58 |
55 |
$1K |
| E0966 |
Manual wheelchair accessory, headrest extension, each |
793 |
676 |
$1K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
178 |
175 |
$1K |
| E2365 |
Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
19 |
13 |
$941.96 |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
26 |
24 |
$748.74 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
631 |
553 |
$651.63 |
| A7526 |
Tracheostomy tube collar/holder, each |
34 |
25 |
$636.56 |
| A4402 |
Lubricant, per ounce |
130 |
123 |
$434.97 |
| A7000 |
Canister, disposable, used with suction pump, each |
27 |
24 |
$285.74 |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
27 |
25 |
$239.28 |
| A4435 |
Ostomy pouch, drainable, high output, with extended wear barrier (one-piece system), with or without filter, each |
53 |
37 |
$185.15 |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
45 |
36 |
$167.22 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
13 |
12 |
$113.60 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
27 |
24 |
$39.18 |
| A7002 |
Tubing, used with suction pump, each |
15 |
13 |
$31.85 |