| 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 |
428 |
354 |
$10K |
| 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 |
47 |
41 |
$5K |
| 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 |
67 |
57 |
$4K |
| E0601 |
Continuous positive airway pressure (cpap) device |
202 |
171 |
$2K |
| K0001 |
Standard wheelchair |
101 |
84 |
$2K |
| A7031 |
Face mask interface, replacement for full face mask, each |
63 |
54 |
$1K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
101 |
83 |
$1K |
| A7030 |
Full face mask used with positive airway pressure device, each |
77 |
65 |
$834.17 |
| E0255 |
Hospital bed, variable height, hi-lo, with any type side rails, with mattress |
68 |
63 |
$738.53 |
| E0570 |
Nebulizer, with compressor |
234 |
223 |
$722.25 |
| E1392 |
Portable oxygen concentrator, rental |
99 |
74 |
$616.83 |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
18 |
14 |
$615.03 |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
30 |
28 |
$564.80 |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
12 |
12 |
$554.16 |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
118 |
105 |
$360.18 |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
15 |
12 |
$270.27 |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
14 |
13 |
$101.84 |
| A7035 |
Headgear used with positive airway pressure device |
45 |
38 |
$81.93 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
166 |
136 |
$66.85 |
| 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 |
45 |
36 |
$65.16 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
48 |
41 |
$1.52 |