| 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 |
2,755 |
2,698 |
$2.14M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
2,932 |
2,877 |
$1.93M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
6,136 |
5,957 |
$1.67M |
| 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 |
6,305 |
6,147 |
$1.45M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
2,528 |
2,494 |
$955K |
| B9998 |
Noc for enteral supplies |
8,596 |
7,156 |
$718K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
7,597 |
7,502 |
$682K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
1,007 |
919 |
$653K |
| 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 |
1,100 |
1,084 |
$424K |
| A4554 |
Disposable underpads, all sizes |
12,633 |
12,155 |
$383K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
2,298 |
2,169 |
$341K |
| 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 |
1,230 |
1,155 |
$324K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
3,573 |
3,419 |
$303K |
| 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 |
768 |
748 |
$295K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
3,134 |
2,473 |
$290K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
2,112 |
2,070 |
$212K |
| 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 |
151 |
150 |
$207K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,762 |
1,732 |
$185K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,200 |
1,191 |
$170K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
1,926 |
1,855 |
$155K |
| A4605 |
Tracheal suction catheter, closed system, each |
1,439 |
1,399 |
$148K |
| A7000 |
Canister, disposable, used with suction pump, each |
7,045 |
6,911 |
$139K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
2,038 |
1,947 |
$125K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
7,184 |
7,075 |
$116K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
902 |
889 |
$97K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
641 |
625 |
$89K |
| A7002 |
Tubing, used with suction pump, each |
7,108 |
6,901 |
$87K |
| A7526 |
Tracheostomy tube collar/holder, each |
3,943 |
3,728 |
$86K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
467 |
450 |
$71K |
| A4335 |
Incontinence supply; miscellaneous |
13,696 |
13,114 |
$70K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
14,192 |
7,380 |
$64K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
884 |
845 |
$51K |
| A4322 |
Irrigation syringe, bulb or piston, each |
5,822 |
5,695 |
$51K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
206 |
206 |
$47K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
500 |
486 |
$46K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
7,291 |
6,863 |
$44K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
329 |
325 |
$41K |
| A4217 |
Sterile water/saline, 500 ml |
1,094 |
974 |
$38K |
| A4623 |
Tracheostomy, inner cannula |
758 |
722 |
$36K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
6,813 |
6,609 |
$34K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,142 |
1,087 |
$33K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
339 |
331 |
$30K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
2,162 |
2,070 |
$30K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
1,618 |
1,341 |
$26K |
| A4927 |
Gloves, non-sterile, per 100 |
3,793 |
3,711 |
$24K |
| 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 |
152 |
151 |
$22K |
| B9002 |
Enteral nutrition infusion pump, any type |
31 |
30 |
$20K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
5,629 |
5,520 |
$18K |
| A4481 |
Tracheostoma filter, any type, any size, each |
1,126 |
1,000 |
$14K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
102 |
102 |
$10K |
| A4402 |
Lubricant, per ounce |
1,862 |
1,850 |
$9K |
| E0601 |
Continuous positive airway pressure (cpap) device |
222 |
215 |
$9K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
5,676 |
5,624 |
$8K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
59 |
55 |
$7K |
| A7525 |
Tracheostomy mask, each |
1,780 |
1,733 |
$5K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
36 |
36 |
$4K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
891 |
865 |
$4K |
| A7012 |
Water collection device, used with large volume nebulizer |
1,014 |
965 |
$4K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
50 |
50 |
$4K |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
310 |
289 |
$3K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
279 |
269 |
$3K |
| E0570 |
Nebulizer, with compressor |
134 |
127 |
$3K |
| A7037 |
Tubing used with positive airway pressure device |
147 |
141 |
$2K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,058 |
1,051 |
$1K |
| A4452 |
Tape, waterproof, per 18 square inches |
130 |
130 |
$978.12 |
| A4244 |
Alcohol or peroxide, per pint |
1,257 |
1,253 |
$870.51 |
| K0001 |
Standard wheelchair |
26 |
26 |
$683.49 |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
49 |
48 |
$681.68 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
206 |
189 |
$630.16 |
| A7035 |
Headgear used with positive airway pressure device |
28 |
26 |
$272.71 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
28 |
25 |
$13.30 |