| 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 |
6,663 |
6,562 |
$264K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,512 |
2,372 |
$144K |
| 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 |
2,180 |
2,070 |
$112K |
| 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 |
1,554 |
1,458 |
$93K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,253 |
2,163 |
$73K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,412 |
2,359 |
$15K |
| B9002 |
Enteral nutrition infusion pump, any type |
397 |
390 |
$8K |
| E0570 |
Nebulizer, with compressor |
1,384 |
1,336 |
$4K |
| E0776 |
Iv pole |
1,809 |
1,796 |
$3K |
| A7037 |
Tubing used with positive airway pressure device |
234 |
233 |
$3K |
| A7031 |
Face mask interface, replacement for full face mask, each |
81 |
80 |
$3K |
| E1392 |
Portable oxygen concentrator, rental |
709 |
709 |
$1K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
407 |
400 |
$1K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
28 |
25 |
$1K |
| A7030 |
Full face mask used with positive airway pressure device, each |
25 |
25 |
$1K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
454 |
424 |
$364.38 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
12 |
12 |
$67.49 |