| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B9998 |
Noc for enteral supplies |
1,338 |
599 |
$187K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
227 |
222 |
$77K |
| 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 |
42 |
37 |
$32K |
| K0001 |
Standard wheelchair |
356 |
350 |
$13K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
126 |
120 |
$11K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
37 |
37 |
$6K |
| A4322 |
Irrigation syringe, bulb or piston, each |
204 |
198 |
$4K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
903 |
378 |
$3K |
| 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 |
22 |
13 |
$2K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
154 |
114 |
$1K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
104 |
85 |
$1K |
| E0776 |
Iv pole |
210 |
191 |
$979.88 |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
36 |
36 |
$968.62 |
| A4335 |
Incontinence supply; miscellaneous |
14 |
12 |
$70.51 |