| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
2,516 |
2,292 |
$289K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
6,768 |
4,623 |
$240K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
923 |
735 |
$194K |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
940 |
848 |
$145K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
4,127 |
2,786 |
$31K |
| B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
42 |
38 |
$17K |
| B9998 |
Noc for enteral supplies |
666 |
325 |
$17K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,117 |
1,597 |
$9K |
| A7031 |
Face mask interface, replacement for full face mask, each |
240 |
166 |
$7K |
| B9002 |
Enteral nutrition infusion pump, any type |
70 |
68 |
$6K |
| E0601 |
Continuous positive airway pressure (cpap) device |
357 |
226 |
$5K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
161 |
116 |
$5K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
523 |
381 |
$5K |
| A7030 |
Full face mask used with positive airway pressure device, each |
100 |
62 |
$3K |
| A7035 |
Headgear used with positive airway pressure device |
362 |
255 |
$3K |
| A7037 |
Tubing used with positive airway pressure device |
376 |
252 |
$3K |
| E0570 |
Nebulizer, with compressor |
366 |
243 |
$2K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
224 |
157 |
$861.12 |
| E0776 |
Iv pole |
28 |
27 |
$166.69 |