| 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 |
6,490 |
5,899 |
$610K |
| E0601 |
Continuous positive airway pressure (cpap) device |
4,414 |
4,259 |
$218K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,236 |
1,178 |
$102K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
4,633 |
4,414 |
$85K |
| 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 |
406 |
385 |
$67K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
3,889 |
3,525 |
$66K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
1,862 |
1,781 |
$51K |
| A7031 |
Face mask interface, replacement for full face mask, each |
951 |
902 |
$35K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
789 |
746 |
$33K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
652 |
628 |
$29K |
| A7035 |
Headgear used with positive airway pressure device |
1,594 |
1,520 |
$28K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
4,903 |
4,696 |
$26K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,555 |
1,480 |
$15K |
| 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 |
50 |
50 |
$11K |
| E0570 |
Nebulizer, with compressor |
319 |
312 |
$5K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
76 |
74 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
180 |
170 |
$191.86 |
| A7037 |
Tubing used with positive airway pressure device |
12 |
12 |
$139.68 |
| E1392 |
Portable oxygen concentrator, rental |
12 |
12 |
$76.84 |