| 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 |
30,568 |
26,354 |
$1.17M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
883 |
629 |
$160K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
406 |
349 |
$90K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
10,749 |
9,243 |
$88K |
| A7031 |
Face mask interface, replacement for full face mask, each |
3,794 |
3,428 |
$83K |
| A7037 |
Tubing used with positive airway pressure device |
5,574 |
5,021 |
$44K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
340 |
274 |
$41K |
| 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 |
239 |
171 |
$41K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,419 |
1,262 |
$40K |
| 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 |
859 |
630 |
$35K |
| 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 |
830 |
570 |
$35K |
| E1392 |
Portable oxygen concentrator, rental |
2,401 |
1,970 |
$34K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
1,212 |
1,065 |
$32K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,295 |
1,136 |
$32K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
1,312 |
1,099 |
$30K |
| B9002 |
Enteral nutrition infusion pump, any type |
410 |
352 |
$27K |
| E0570 |
Nebulizer, with compressor |
2,834 |
2,355 |
$18K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
6,553 |
5,861 |
$18K |
| A7035 |
Headgear used with positive airway pressure device |
1,877 |
1,683 |
$16K |
| 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 |
291 |
227 |
$14K |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
1,296 |
1,050 |
$10K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,618 |
1,457 |
$10K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,354 |
1,148 |
$9K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
684 |
646 |
$9K |
| B9998 |
Noc for enteral supplies |
933 |
599 |
$7K |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
445 |
381 |
$4K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
3,276 |
2,866 |
$4K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
1,031 |
941 |
$3K |
| E0776 |
Iv pole |
320 |
297 |
$3K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
259 |
234 |
$2K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
32 |
26 |
$2K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
203 |
188 |
$1K |
| A7015 |
Aerosol mask, used with dme nebulizer |
96 |
81 |
$55.14 |
| A7004 |
Small volume nonfiltered pneumatic nebulizer, disposable |
86 |
78 |
$33.78 |