| 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 |
4,405 |
3,840 |
$110K |
| 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 |
437 |
417 |
$65K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,346 |
1,187 |
$29K |
| A7030 |
Full face mask used with positive airway pressure device, each |
579 |
497 |
$19K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,526 |
2,261 |
$17K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
46 |
41 |
$8K |
| 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 |
42 |
37 |
$6K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,280 |
1,987 |
$6K |
| A7037 |
Tubing used with positive airway pressure device |
922 |
792 |
$4K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
305 |
274 |
$3K |
| 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 |
13 |
12 |
$3K |
| E0601 |
Continuous positive airway pressure (cpap) device |
94 |
75 |
$2K |
| A7035 |
Headgear used with positive airway pressure device |
303 |
263 |
$2K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
46 |
25 |
$441.76 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
98 |
85 |
$243.21 |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
25 |
24 |
$238.90 |
| E1392 |
Portable oxygen concentrator, rental |
77 |
65 |
$148.94 |
| E0776 |
Iv pole |
13 |
13 |
$125.14 |