| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,541 |
4,123 |
$1.29M |
| E1399 |
Durable medical equipment, miscellaneous |
2,033 |
408 |
$1.10M |
| 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 |
1,230 |
1,145 |
$1.08M |
| B9998 |
Noc for enteral supplies |
7,978 |
4,581 |
$932K |
| 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 |
582 |
536 |
$907K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
6,180 |
2,778 |
$626K |
| 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 |
1,460 |
1,374 |
$505K |
| 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 |
985 |
866 |
$377K |
| 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 |
1,234 |
1,052 |
$345K |
| A4554 |
Disposable underpads, all sizes |
6,788 |
6,270 |
$228K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,764 |
1,613 |
$181K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
2,004 |
1,397 |
$161K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,311 |
1,212 |
$148K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
1,244 |
1,151 |
$141K |
| 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 |
369 |
348 |
$134K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
754 |
654 |
$129K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
823 |
723 |
$95K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
669 |
629 |
$67K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
652 |
602 |
$67K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
638 |
599 |
$65K |
| A7000 |
Canister, disposable, used with suction pump, each |
2,561 |
2,334 |
$64K |
| A4322 |
Irrigation syringe, bulb or piston, each |
5,659 |
4,420 |
$57K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
197 |
182 |
$51K |
| A4335 |
Incontinence supply; miscellaneous |
8,156 |
7,602 |
$50K |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
159 |
26 |
$48K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
3,717 |
3,387 |
$46K |
| A7002 |
Tubing, used with suction pump, each |
2,601 |
2,359 |
$44K |
| 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 |
81 |
74 |
$33K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
1,142 |
828 |
$32K |
| A4927 |
Gloves, non-sterile, per 100 |
4,520 |
4,170 |
$30K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
127 |
122 |
$27K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,218 |
1,038 |
$25K |
| A4657 |
Syringe, with or without needle, each |
3,150 |
3,004 |
$23K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
957 |
864 |
$22K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
2,953 |
2,669 |
$22K |
| E0277 |
Powered pressure-reducing air mattress |
95 |
82 |
$19K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
152 |
142 |
$19K |
| A4452 |
Tape, waterproof, per 18 square inches |
1,757 |
1,609 |
$16K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
87 |
74 |
$12K |
| B4104 |
Additive for enteral formula (e.g., fiber) |
68 |
65 |
$11K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
120 |
103 |
$10K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
2,611 |
2,448 |
$9K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
1,139 |
1,014 |
$7K |
| B9002 |
Enteral nutrition infusion pump, any type |
24 |
24 |
$7K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
62 |
59 |
$6K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
1,697 |
1,507 |
$5K |
| A7015 |
Aerosol mask, used with dme nebulizer |
2,395 |
2,235 |
$3K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
24 |
24 |
$3K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
181 |
167 |
$3K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
114 |
107 |
$2K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
607 |
542 |
$1K |
| B4100 |
Food thickener, administered orally, per ounce |
25 |
25 |
$1K |
| A4402 |
Lubricant, per ounce |
139 |
134 |
$729.49 |