| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
435 |
360 |
$90K |
| 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 |
80 |
75 |
$46K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
103 |
99 |
$35K |
| B9998 |
Noc for enteral supplies |
258 |
113 |
$33K |
| E0601 |
Continuous positive airway pressure (cpap) device |
497 |
496 |
$29K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
101 |
97 |
$15K |
| K0001 |
Standard wheelchair |
322 |
303 |
$11K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
38 |
28 |
$5K |
| A4554 |
Disposable underpads, all sizes |
118 |
101 |
$3K |
| A4335 |
Incontinence supply; miscellaneous |
512 |
488 |
$3K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
88 |
84 |
$2K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
229 |
150 |
$2K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
288 |
123 |
$1K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
58 |
53 |
$674.18 |
| A4322 |
Irrigation syringe, bulb or piston, each |
29 |
27 |
$228.38 |
| E0776 |
Iv pole |
25 |
25 |
$192.25 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
38 |
38 |
$163.58 |
| A7015 |
Aerosol mask, used with dme nebulizer |
12 |
12 |
$18.70 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
24 |
24 |
$15.25 |