| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
932 |
907 |
$917K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,249 |
2,181 |
$742K |
| 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 |
1,283 |
1,260 |
$448K |
| B9998 |
Noc for enteral supplies |
3,443 |
2,436 |
$367K |
| A4554 |
Disposable underpads, all sizes |
4,894 |
4,741 |
$152K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,279 |
1,219 |
$143K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
930 |
875 |
$130K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
1,317 |
1,269 |
$127K |
| B9002 |
Enteral nutrition infusion pump, any type |
403 |
395 |
$112K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
604 |
592 |
$84K |
| A4322 |
Irrigation syringe, bulb or piston, each |
1,908 |
1,689 |
$57K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
385 |
363 |
$48K |
| A4927 |
Gloves, non-sterile, per 100 |
5,492 |
5,307 |
$41K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
116 |
106 |
$41K |
| A4335 |
Incontinence supply; miscellaneous |
6,510 |
6,188 |
$36K |
| A7000 |
Canister, disposable, used with suction pump, each |
538 |
509 |
$34K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
260 |
245 |
$32K |
| A4657 |
Syringe, with or without needle, each |
2,145 |
2,106 |
$28K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,630 |
1,522 |
$27K |
| 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 |
67 |
66 |
$27K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
3,079 |
2,844 |
$26K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
273 |
272 |
$25K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
179 |
176 |
$18K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
661 |
641 |
$16K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
161 |
155 |
$16K |
| A7002 |
Tubing, used with suction pump, each |
549 |
533 |
$12K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,437 |
1,356 |
$8K |
| 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 |
12 |
12 |
$8K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
53 |
49 |
$7K |
| A9901 |
Dme delivery, set up, and/or dispensing service component of another hcpcs code |
13 |
13 |
$6K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
656 |
639 |
$5K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
948 |
925 |
$4K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
398 |
386 |
$3K |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
26 |
26 |
$27.83 |