| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
33,696 |
30,235 |
$8.56M |
| 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 |
7,976 |
6,722 |
$5.23M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
3,457 |
3,023 |
$2.41M |
| 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 |
3,985 |
3,338 |
$1.94M |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
4,366 |
3,925 |
$1.90M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
10,121 |
8,175 |
$1.85M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
16,494 |
15,384 |
$1.71M |
| 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 |
6,376 |
5,495 |
$1.62M |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
11,270 |
10,444 |
$1.19M |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
10,663 |
8,504 |
$1.02M |
| A4554 |
Disposable underpads, all sizes |
19,014 |
15,007 |
$796K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
6,970 |
5,960 |
$791K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
5,755 |
4,178 |
$770K |
| 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 |
1,129 |
993 |
$767K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
4,787 |
3,642 |
$753K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
5,526 |
4,772 |
$753K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
4,229 |
3,438 |
$595K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
2,563 |
2,182 |
$577K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
4,061 |
3,249 |
$573K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
3,533 |
3,033 |
$573K |
| A7526 |
Tracheostomy tube collar/holder, each |
5,981 |
5,466 |
$560K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
646 |
562 |
$500K |
| B9998 |
Noc for enteral supplies |
2,226 |
1,902 |
$470K |
| A4605 |
Tracheal suction catheter, closed system, each |
1,460 |
1,351 |
$455K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
3,816 |
3,214 |
$419K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
4,214 |
3,442 |
$418K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
3,733 |
3,238 |
$410K |
| 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 |
1,559 |
1,326 |
$319K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
13,704 |
12,669 |
$292K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
2,700 |
1,678 |
$289K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,821 |
1,312 |
$284K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
2,896 |
2,710 |
$262K |
| B9002 |
Enteral nutrition infusion pump, any type |
2,722 |
2,080 |
$245K |
| E0570 |
Nebulizer, with compressor |
3,864 |
3,131 |
$240K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,913 |
1,712 |
$229K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
334 |
292 |
$221K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,726 |
1,411 |
$218K |
| 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 |
923 |
808 |
$211K |
| A4927 |
Gloves, non-sterile, per 100 |
19,634 |
16,150 |
$209K |
| A7000 |
Canister, disposable, used with suction pump, each |
9,176 |
8,532 |
$197K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
7,907 |
7,106 |
$193K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
2,826 |
2,431 |
$191K |
| L8501 |
Tracheostomy speaking valve |
1,985 |
1,842 |
$187K |
| 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 |
2,289 |
2,023 |
$178K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
3,125 |
2,603 |
$152K |
| E0601 |
Continuous positive airway pressure (cpap) device |
486 |
421 |
$150K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
685 |
627 |
$150K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
3,965 |
3,397 |
$144K |
| B4162 |
Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
365 |
299 |
$138K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
869 |
624 |
$134K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
1,244 |
1,111 |
$133K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
851 |
746 |
$132K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,201 |
1,020 |
$131K |
| K0001 |
Standard wheelchair |
3,736 |
3,310 |
$129K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
2,136 |
1,364 |
$125K |
| S8189 |
Tracheostomy supply, not otherwise classified |
4,538 |
3,577 |
$125K |
| B4224 |
Parenteral nutrition administration kit, per day |
868 |
222 |
$122K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
2,091 |
1,868 |
$120K |
| A7002 |
Tubing, used with suction pump, each |
8,910 |
8,176 |
$110K |
| B4158 |
Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
903 |
747 |
$107K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
254 |
212 |
$102K |
| 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 |
2,915 |
2,823 |
$102K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,620 |
1,446 |
$98K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
3,572 |
1,657 |
$96K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
2,611 |
2,261 |
$87K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
248 |
180 |
$86K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,760 |
1,394 |
$71K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
809 |
599 |
$71K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
3,138 |
2,807 |
$66K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
678 |
497 |
$64K |
| E0619 |
Apnea monitor, with recording feature |
190 |
182 |
$61K |
| A4217 |
Sterile water/saline, 500 ml |
1,128 |
968 |
$60K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,840 |
4,171 |
$59K |
| S8120 |
Oxygen contents, gaseous, 1 unit equals 1 cubic foot |
2,153 |
1,245 |
$59K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
3,982 |
3,552 |
$55K |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
1,347 |
1,234 |
$53K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
462 |
429 |
$42K |
| A6207 |
Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
217 |
190 |
$42K |
| B4220 |
Parenteral nutrition supply kit; premix, per day |
871 |
222 |
$41K |
| A7035 |
Headgear used with positive airway pressure device |
1,708 |
1,487 |
$41K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
309 |
260 |
$38K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
241 |
204 |
$36K |
| A4553 |
Non-disposable underpads, all sizes |
2,553 |
2,270 |
$34K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
104 |
86 |
$29K |
| A5120 |
Skin barrier, wipes or swabs, each |
1,995 |
1,638 |
$29K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
99 |
94 |
$27K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
7,330 |
6,539 |
$26K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,817 |
1,597 |
$26K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
2,718 |
2,432 |
$25K |
| A7037 |
Tubing used with positive airway pressure device |
957 |
896 |
$23K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,904 |
3,341 |
$22K |
| A7525 |
Tracheostomy mask, each |
3,016 |
2,766 |
$20K |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
1,172 |
1,100 |
$20K |
| A6453 |
Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard |
6,057 |
5,453 |
$19K |
| A4332 |
Lubricant, individual sterile packet, each |
6,553 |
5,987 |
$19K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
237 |
150 |
$18K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
141 |
139 |
$17K |
| A7012 |
Water collection device, used with large volume nebulizer |
2,215 |
2,005 |
$17K |
| K0003 |
Lightweight wheelchair |
329 |
314 |
$17K |
| E1392 |
Portable oxygen concentrator, rental |
428 |
390 |
$16K |
| A4322 |
Irrigation syringe, bulb or piston, each |
425 |
350 |
$14K |
| E0471 |
Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
39 |
39 |
$12K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
1,176 |
968 |
$11K |
| A7015 |
Aerosol mask, used with dme nebulizer |
4,221 |
3,663 |
$11K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
1,849 |
1,633 |
$10K |
| A4456 |
Adhesive remover, wipes, any type, each |
605 |
541 |
$9K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
125 |
122 |
$7K |
| A7018 |
Water, distilled, used with large volume nebulizer, 1000 ml |
2,188 |
1,924 |
$7K |
| A6210 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
13 |
12 |
$5K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
45 |
36 |
$5K |
| A4402 |
Lubricant, per ounce |
184 |
167 |
$3K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
57 |
45 |
$3K |
| A4452 |
Tape, waterproof, per 18 square inches |
97 |
88 |
$3K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
1,375 |
983 |
$3K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
123 |
101 |
$3K |
| A7527 |
Tracheostomy/laryngectomy tube plug/stop, each |
242 |
236 |
$2K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
22 |
12 |
$2K |
| E0434 |
Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing |
35 |
24 |
$1K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
70 |
65 |
$485.46 |
| A4657 |
Syringe, with or without needle, each |
68 |
61 |
$131.90 |