| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
399 |
316 |
$99K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,213 |
1,863 |
$95K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,102 |
965 |
$46K |
| 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 |
743 |
463 |
$28K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
445 |
297 |
$25K |
| 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 |
195 |
145 |
$15K |
| E0570 |
Nebulizer, with compressor |
583 |
512 |
$12K |
| A7030 |
Full face mask used with positive airway pressure device, each |
151 |
137 |
$11K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
342 |
303 |
$10K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
181 |
169 |
$10K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
457 |
382 |
$9K |
| K0001 |
Standard wheelchair |
596 |
493 |
$6K |
| E1392 |
Portable oxygen concentrator, rental |
378 |
328 |
$6K |
| B9002 |
Enteral nutrition infusion pump, any type |
237 |
187 |
$4K |
| K0003 |
Lightweight wheelchair |
122 |
110 |
$3K |
| A7035 |
Headgear used with positive airway pressure device |
236 |
215 |
$3K |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
438 |
411 |
$3K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
66 |
59 |
$2K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
37 |
27 |
$1K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
127 |
103 |
$1K |
| A7031 |
Face mask interface, replacement for full face mask, each |
28 |
26 |
$1K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
451 |
384 |
$1K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
168 |
148 |
$1K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
14 |
13 |
$761.28 |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
31 |
26 |
$680.71 |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
15 |
13 |
$286.67 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
143 |
130 |
$259.36 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
106 |
95 |
$38.13 |