| 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 |
25,603 |
22,673 |
$2.36M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
10,792 |
7,881 |
$1.63M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
2,161 |
1,382 |
$1.01M |
| 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 |
2,399 |
1,746 |
$956K |
| B9998 |
Noc for enteral supplies |
12,092 |
8,315 |
$733K |
| E0570 |
Nebulizer, with compressor |
11,480 |
10,289 |
$617K |
| A7030 |
Full face mask used with positive airway pressure device, each |
5,288 |
4,728 |
$536K |
| 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 |
4,324 |
3,032 |
$507K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
2,110 |
1,789 |
$496K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
3,432 |
3,044 |
$480K |
| E0601 |
Continuous positive airway pressure (cpap) device |
6,498 |
5,640 |
$479K |
| B4149 |
Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
2,053 |
1,310 |
$459K |
| A7031 |
Face mask interface, replacement for full face mask, each |
6,869 |
6,210 |
$448K |
| 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 |
12,344 |
11,206 |
$306K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
1,794 |
1,634 |
$305K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
2,036 |
1,708 |
$258K |
| B9002 |
Enteral nutrition infusion pump, any type |
2,551 |
2,086 |
$242K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,884 |
1,675 |
$185K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
4,111 |
3,763 |
$183K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
1,459 |
1,347 |
$181K |
| 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) |
1,516 |
1,293 |
$166K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,507 |
1,208 |
$159K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
9,360 |
8,383 |
$158K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
4,235 |
2,588 |
$146K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,245 |
1,061 |
$145K |
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
1,833 |
1,389 |
$145K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
4,134 |
4,011 |
$145K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
737 |
690 |
$143K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
767 |
320 |
$137K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
3,171 |
2,902 |
$134K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
5,937 |
5,510 |
$129K |
| A7035 |
Headgear used with positive airway pressure device |
5,771 |
5,194 |
$126K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
3,076 |
2,756 |
$124K |
| L4386 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
1,109 |
1,054 |
$121K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
2,255 |
2,102 |
$110K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
4,492 |
4,271 |
$107K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
2,078 |
1,966 |
$103K |
| K0003 |
Lightweight wheelchair |
2,472 |
2,096 |
$101K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,272 |
986 |
$99K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
3,374 |
3,284 |
$93K |
| E1399 |
Durable medical equipment, miscellaneous |
4,024 |
1,883 |
$91K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
447 |
426 |
$85K |
| K0001 |
Standard wheelchair |
3,651 |
3,160 |
$82K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
1,330 |
1,094 |
$79K |
| 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 |
796 |
579 |
$73K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,893 |
1,637 |
$65K |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
503 |
486 |
$62K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
598 |
506 |
$62K |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
137 |
107 |
$52K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
1,197 |
964 |
$50K |
| A4554 |
Disposable underpads, all sizes |
2,175 |
1,904 |
$46K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
314 |
247 |
$42K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
152 |
152 |
$38K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
1,461 |
1,286 |
$37K |
| A7526 |
Tracheostomy tube collar/holder, each |
1,807 |
1,488 |
$37K |
| E0619 |
Apnea monitor, with recording feature |
163 |
146 |
$36K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
3,445 |
3,069 |
$35K |
| A4927 |
Gloves, non-sterile, per 100 |
2,409 |
1,986 |
$34K |
| A7000 |
Canister, disposable, used with suction pump, each |
2,750 |
2,406 |
$33K |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
283 |
226 |
$33K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
704 |
527 |
$33K |
| A7002 |
Tubing, used with suction pump, each |
3,677 |
2,621 |
$27K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
11,147 |
4,817 |
$24K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
572 |
502 |
$23K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
2,177 |
1,780 |
$21K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
229 |
212 |
$20K |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
283 |
55 |
$19K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
387 |
324 |
$19K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
658 |
539 |
$18K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
281 |
208 |
$18K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
182 |
141 |
$17K |
| L3260 |
Surgical boot/shoe, each |
1,039 |
947 |
$17K |
| A7037 |
Tubing used with positive airway pressure device |
4,389 |
3,981 |
$15K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
178 |
146 |
$15K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
374 |
283 |
$13K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
1,919 |
920 |
$13K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
5,339 |
4,763 |
$12K |
| E0202 |
Phototherapy (bilirubin) light with photometer |
25 |
24 |
$11K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
5,589 |
4,674 |
$11K |
| K0004 |
High strength, lightweight wheelchair |
104 |
97 |
$9K |
| A4565 |
Slings |
1,437 |
1,405 |
$8K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
224 |
190 |
$8K |
| E1392 |
Portable oxygen concentrator, rental |
2,136 |
1,859 |
$6K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
2,119 |
1,956 |
$6K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
765 |
551 |
$6K |
| A7015 |
Aerosol mask, used with dme nebulizer |
3,091 |
2,906 |
$5K |
| A4456 |
Adhesive remover, wipes, any type, each |
602 |
534 |
$4K |
| K0052 |
Swingaway, detachable footrests, replacement only, each |
898 |
449 |
$4K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
574 |
495 |
$4K |
| A4217 |
Sterile water/saline, 500 ml |
348 |
216 |
$3K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
480 |
411 |
$3K |
| E1020 |
Residual limb support system for wheelchair, any type |
87 |
78 |
$3K |
| K0053 |
Elevating footrests, articulating (telescoping), each |
142 |
117 |
$3K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
83 |
65 |
$3K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
32 |
26 |
$3K |
| A5120 |
Skin barrier, wipes or swabs, each |
624 |
524 |
$3K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
40 |
38 |
$2K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
38 |
36 |
$2K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
84 |
37 |
$2K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
109 |
94 |
$2K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
17 |
13 |
$1K |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
30 |
28 |
$1K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
14 |
12 |
$1K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
179 |
143 |
$1K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
205 |
155 |
$1K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
16 |
13 |
$1K |
| A4605 |
Tracheal suction catheter, closed system, each |
45 |
25 |
$899.43 |
| E0181 |
Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty |
68 |
62 |
$767.34 |
| A4452 |
Tape, waterproof, per 18 square inches |
119 |
71 |
$576.44 |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
13 |
12 |
$478.03 |
| A4371 |
Ostomy skin barrier, powder, per oz |
142 |
122 |
$350.59 |
| L2999 |
Lower extremity orthoses, not otherwise specified |
32 |
26 |
$301.86 |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
13 |
12 |
$292.68 |
| E0156 |
Seat attachment, walker |
43 |
40 |
$275.12 |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
21 |
12 |
$255.67 |
| A4618 |
Breathing circuits |
41 |
24 |
$164.00 |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
37 |
24 |
$122.81 |
| A4245 |
Alcohol wipes, per box |
15 |
14 |
$76.10 |
| A4649 |
Surgical supply; miscellaneous |
16 |
12 |
$74.74 |
| A4209 |
Syringe with needle, sterile 5 cc or greater, each |
41 |
16 |
$51.60 |
| A4481 |
Tracheostoma filter, any type, any size, each |
15 |
12 |
$10.74 |
| A4215 |
Needle, sterile, any size, each |
26 |
15 |
$8.14 |
| A4930 |
Gloves, sterile, per pair |
103 |
88 |
$0.00 |