| 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 |
2,526 |
2,457 |
$2.31M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,079 |
4,025 |
$1.23M |
| 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 |
3,777 |
3,660 |
$1.06M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
1,128 |
1,119 |
$1.00M |
| 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 |
502 |
460 |
$695K |
| B9998 |
Noc for enteral supplies |
5,988 |
5,046 |
$577K |
| 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 |
952 |
941 |
$463K |
| A4554 |
Disposable underpads, all sizes |
12,218 |
11,998 |
$350K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,684 |
2,627 |
$337K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,450 |
2,420 |
$300K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
2,485 |
2,262 |
$270K |
| 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 |
868 |
847 |
$255K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
1,176 |
1,148 |
$204K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
2,238 |
2,214 |
$201K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,704 |
1,683 |
$180K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
1,348 |
1,314 |
$147K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
213 |
197 |
$137K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
1,053 |
1,038 |
$106K |
| A7000 |
Canister, disposable, used with suction pump, each |
3,151 |
3,128 |
$105K |
| A4322 |
Irrigation syringe, bulb or piston, each |
4,522 |
4,435 |
$100K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
856 |
846 |
$75K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
683 |
677 |
$74K |
| A4335 |
Incontinence supply; miscellaneous |
13,982 |
13,622 |
$71K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
3,048 |
3,018 |
$67K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,312 |
1,286 |
$61K |
| A7526 |
Tracheostomy tube collar/holder, each |
1,668 |
1,503 |
$61K |
| A7002 |
Tubing, used with suction pump, each |
3,177 |
3,112 |
$61K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
316 |
308 |
$42K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,689 |
1,660 |
$42K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
5,994 |
4,128 |
$39K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
316 |
312 |
$36K |
| 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 |
97 |
96 |
$32K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
261 |
255 |
$29K |
| A4927 |
Gloves, non-sterile, per 100 |
3,553 |
3,509 |
$26K |
| A4605 |
Tracheal suction catheter, closed system, each |
118 |
101 |
$25K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,401 |
4,270 |
$23K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
3,162 |
3,118 |
$20K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
3,545 |
3,489 |
$13K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
469 |
411 |
$11K |
| A4402 |
Lubricant, per ounce |
1,901 |
1,887 |
$10K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
3,939 |
3,894 |
$7K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
1,961 |
1,941 |
$6K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
63 |
63 |
$6K |
| A7525 |
Tracheostomy mask, each |
1,017 |
1,008 |
$5K |
| A4217 |
Sterile water/saline, 500 ml |
294 |
288 |
$3K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
582 |
576 |
$2K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,314 |
1,298 |
$2K |
| A4244 |
Alcohol or peroxide, per pint |
647 |
645 |
$465.37 |
| A4481 |
Tracheostoma filter, any type, any size, each |
12 |
12 |
$168.25 |