| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
5,810 |
5,657 |
$487K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
5,630 |
5,611 |
$349K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,827 |
1,818 |
$72K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,405 |
2,399 |
$45K |
| E0570 |
Nebulizer, with compressor |
1,930 |
1,918 |
$37K |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
1,280 |
1,257 |
$31K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
1,143 |
1,135 |
$31K |
| A7030 |
Full face mask used with positive airway pressure device, each |
596 |
589 |
$24K |
| K0003 |
Lightweight wheelchair |
1,196 |
1,181 |
$23K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,684 |
1,672 |
$22K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
577 |
565 |
$20K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,527 |
1,514 |
$16K |
| A7037 |
Tubing used with positive airway pressure device |
1,096 |
1,083 |
$11K |
| A7035 |
Headgear used with positive airway pressure device |
812 |
802 |
$10K |
| 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 |
1,176 |
1,172 |
$10K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,220 |
1,202 |
$4K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
109 |
107 |
$3K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
72 |
65 |
$3K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
106 |
106 |
$3K |
| A7031 |
Face mask interface, replacement for full face mask, each |
146 |
142 |
$2K |
| S5199 |
Personal care item, nos, each |
227 |
227 |
$2K |
| A4259 |
Lancets, per box of 100 |
355 |
349 |
$2K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,531 |
1,515 |
$1K |