| 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 |
8,057 |
4,220 |
$671K |
| 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 |
6,748 |
5,789 |
$621K |
| 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 |
1,446 |
1,115 |
$607K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
8,938 |
5,816 |
$348K |
| 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 |
3,916 |
2,563 |
$279K |
| 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 |
2,116 |
1,697 |
$160K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,744 |
2,023 |
$139K |
| 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 |
853 |
553 |
$108K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,740 |
1,592 |
$56K |
| 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 |
343 |
266 |
$51K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
425 |
371 |
$38K |
| A7030 |
Full face mask used with positive airway pressure device, each |
762 |
514 |
$24K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
4,076 |
2,622 |
$22K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
2,477 |
1,459 |
$17K |
| 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 |
42 |
37 |
$15K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,195 |
745 |
$14K |
| E1392 |
Portable oxygen concentrator, rental |
1,065 |
671 |
$13K |
| A7035 |
Headgear used with positive airway pressure device |
1,032 |
732 |
$10K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
3,255 |
2,350 |
$8K |
| E0570 |
Nebulizer, with compressor |
1,903 |
1,485 |
$8K |
| A7037 |
Tubing used with positive airway pressure device |
535 |
373 |
$6K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
179 |
127 |
$4K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
456 |
309 |
$2K |
| E0776 |
Iv pole |
42 |
25 |
$144.03 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
452 |
296 |
$118.95 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
93 |
64 |
$118.86 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
17 |
13 |
$43.89 |