| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
2,058 |
2,040 |
$1.65M |
| 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 |
1,608 |
1,580 |
$1.23M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
9,659 |
9,572 |
$1.04M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,813 |
3,719 |
$1.01M |
| 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 |
2,863 |
2,821 |
$665K |
| B9998 |
Noc for enteral supplies |
4,987 |
4,156 |
$424K |
| 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 |
969 |
963 |
$411K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
3,940 |
3,886 |
$383K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
1,395 |
1,370 |
$349K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
471 |
454 |
$315K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
1,831 |
1,812 |
$278K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
2,200 |
2,149 |
$277K |
| 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 |
818 |
809 |
$234K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
2,168 |
2,125 |
$203K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
9,186 |
9,118 |
$179K |
| E0570 |
Nebulizer, with compressor |
1,691 |
1,679 |
$163K |
| A7000 |
Canister, disposable, used with suction pump, each |
5,075 |
5,035 |
$127K |
| A4554 |
Disposable underpads, all sizes |
4,307 |
4,238 |
$127K |
| B9002 |
Enteral nutrition infusion pump, any type |
982 |
972 |
$126K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
995 |
977 |
$111K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,828 |
1,769 |
$105K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
1,054 |
1,037 |
$97K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
790 |
767 |
$81K |
| A7526 |
Tracheostomy tube collar/holder, each |
2,609 |
2,478 |
$67K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,629 |
4,323 |
$64K |
| A7002 |
Tubing, used with suction pump, each |
5,216 |
5,156 |
$61K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
388 |
382 |
$54K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
4,626 |
3,391 |
$54K |
| K0001 |
Standard wheelchair |
2,216 |
2,186 |
$52K |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
165 |
163 |
$44K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
357 |
353 |
$39K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
2,259 |
2,178 |
$34K |
| A4217 |
Sterile water/saline, 500 ml |
1,339 |
1,285 |
$29K |
| A4322 |
Irrigation syringe, bulb or piston, each |
3,414 |
3,389 |
$26K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
1,041 |
1,040 |
$26K |
| A4335 |
Incontinence supply; miscellaneous |
5,152 |
5,043 |
$25K |
| A4605 |
Tracheal suction catheter, closed system, each |
171 |
166 |
$23K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
2,239 |
2,216 |
$19K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
3,492 |
3,448 |
$19K |
| E0483 |
High frequency chest wall oscillation system, with full anterior and/or posterior thoracic region receiving simultaneous external oscillation, includes all accessories and supplies, each |
25 |
24 |
$18K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
159 |
146 |
$15K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
138 |
137 |
$14K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
116 |
116 |
$13K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
4,806 |
4,756 |
$12K |
| A4452 |
Tape, waterproof, per 18 square inches |
644 |
596 |
$12K |
| E0601 |
Continuous positive airway pressure (cpap) device |
247 |
243 |
$10K |
| A4481 |
Tracheostoma filter, any type, any size, each |
688 |
595 |
$10K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
838 |
824 |
$6K |
| E0776 |
Iv pole |
663 |
658 |
$6K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
708 |
691 |
$5K |
| A7015 |
Aerosol mask, used with dme nebulizer |
2,896 |
2,863 |
$3K |
| A7030 |
Full face mask used with positive airway pressure device, each |
40 |
40 |
$3K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
174 |
171 |
$3K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
556 |
518 |
$3K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
284 |
280 |
$3K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
28 |
24 |
$3K |
| A7012 |
Water collection device, used with large volume nebulizer |
483 |
474 |
$2K |
| A7037 |
Tubing used with positive airway pressure device |
134 |
134 |
$2K |
| A7525 |
Tracheostomy mask, each |
735 |
720 |
$2K |
| A4332 |
Lubricant, individual sterile packet, each |
402 |
390 |
$1K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
257 |
256 |
$952.35 |
| A7035 |
Headgear used with positive airway pressure device |
13 |
13 |
$143.35 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
12 |
12 |
$51.43 |