| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,824 |
2,761 |
$158K |
| 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 |
555 |
416 |
$106K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,159 |
1,138 |
$51K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
285 |
243 |
$50K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
969 |
949 |
$12K |
| B9002 |
Enteral nutrition infusion pump, any type |
171 |
169 |
$9K |
| 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 |
20 |
12 |
$8K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,058 |
1,000 |
$6K |
| A7035 |
Headgear used with positive airway pressure device |
210 |
196 |
$3K |
| 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 |
185 |
118 |
$3K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
51 |
51 |
$2K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
80 |
77 |
$2K |
| A7030 |
Full face mask used with positive airway pressure device, each |
26 |
26 |
$2K |
| 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 |
41 |
27 |
$1K |
| A7031 |
Face mask interface, replacement for full face mask, each |
42 |
39 |
$1K |
| 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 |
67 |
63 |
$962.93 |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
26 |
24 |
$953.91 |
| A7037 |
Tubing used with positive airway pressure device |
27 |
24 |
$365.14 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
31 |
28 |
$230.78 |