| 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 |
3,187 |
2,822 |
$431K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
2,498 |
2,249 |
$383K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,758 |
1,557 |
$376K |
| E0570 |
Nebulizer, with compressor |
2,847 |
2,381 |
$259K |
| 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 |
1,288 |
1,070 |
$178K |
| 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 |
1,192 |
1,021 |
$170K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
3,622 |
3,123 |
$137K |
| A4554 |
Disposable underpads, all sizes |
2,807 |
2,563 |
$136K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,684 |
1,481 |
$116K |
| A4927 |
Gloves, non-sterile, per 100 |
2,611 |
2,439 |
$64K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
489 |
447 |
$62K |
| A4217 |
Sterile water/saline, 500 ml |
734 |
533 |
$52K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,317 |
1,984 |
$48K |
| B9998 |
Noc for enteral supplies |
2,890 |
2,086 |
$39K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
234 |
211 |
$24K |
| A7031 |
Face mask interface, replacement for full face mask, each |
477 |
427 |
$23K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,505 |
1,324 |
$17K |
| A7030 |
Full face mask used with positive airway pressure device, each |
113 |
100 |
$15K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
1,619 |
1,367 |
$13K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
57 |
51 |
$11K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
43 |
36 |
$11K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
573 |
444 |
$8K |
| A7002 |
Tubing, used with suction pump, each |
1,647 |
1,383 |
$7K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
886 |
752 |
$7K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
531 |
396 |
$7K |
| A7035 |
Headgear used with positive airway pressure device |
244 |
215 |
$6K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,236 |
1,071 |
$6K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
56 |
49 |
$6K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
2,088 |
1,814 |
$5K |
| A7037 |
Tubing used with positive airway pressure device |
119 |
99 |
$3K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
86 |
82 |
$3K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,857 |
1,628 |
$3K |
| A7526 |
Tracheostomy tube collar/holder, each |
104 |
89 |
$3K |
| 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 |
17 |
13 |
$2K |
| A7004 |
Small volume nonfiltered pneumatic nebulizer, disposable |
617 |
531 |
$2K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
170 |
146 |
$2K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
69 |
66 |
$812.71 |
| XZERO |
|
78 |
38 |
$0.00 |