| 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 |
26,399 |
18,201 |
$1.02M |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
17,370 |
12,437 |
$153K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,433 |
1,744 |
$120K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
595 |
452 |
$118K |
| A7031 |
Face mask interface, replacement for full face mask, each |
3,074 |
2,285 |
$113K |
| 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 |
771 |
703 |
$81K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,097 |
875 |
$37K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,107 |
810 |
$34K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
603 |
455 |
$27K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
5,007 |
3,941 |
$24K |
| 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 |
124 |
105 |
$19K |
| A7037 |
Tubing used with positive airway pressure device |
1,986 |
1,417 |
$18K |
| A7035 |
Headgear used with positive airway pressure device |
1,918 |
1,425 |
$17K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,163 |
949 |
$13K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,190 |
842 |
$13K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,626 |
1,168 |
$7K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
109 |
97 |
$4K |
| E0570 |
Nebulizer, with compressor |
685 |
538 |
$2K |
| E1392 |
Portable oxygen concentrator, rental |
435 |
265 |
$1K |
| K0001 |
Standard wheelchair |
30 |
25 |
$665.83 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
167 |
148 |
$170.13 |