| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
1,146 |
1,146 |
$1.30M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,620 |
3,607 |
$858K |
| B4149 |
Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
1,184 |
1,165 |
$542K |
| 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 |
489 |
482 |
$389K |
| A6218 |
Gauze, non-impregnated, non-sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
1,411 |
1,411 |
$261K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
2,116 |
2,113 |
$192K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
1,635 |
1,635 |
$189K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
1,450 |
1,449 |
$129K |
| A4322 |
Irrigation syringe, bulb or piston, each |
1,407 |
1,403 |
$128K |
| A7526 |
Tracheostomy tube collar/holder, each |
1,386 |
1,386 |
$96K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
368 |
367 |
$83K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
439 |
433 |
$69K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
358 |
358 |
$64K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,933 |
1,933 |
$63K |
| A4605 |
Tracheal suction catheter, closed system, each |
914 |
914 |
$62K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,647 |
2,645 |
$61K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
1,401 |
1,399 |
$49K |
| A4209 |
Syringe with needle, sterile 5 cc or greater, each |
2,287 |
2,283 |
$46K |
| A4452 |
Tape, waterproof, per 18 square inches |
1,185 |
1,179 |
$45K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
268 |
267 |
$42K |
| 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 |
135 |
135 |
$40K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,400 |
1,400 |
$30K |
| A7503 |
Filter holder or filter cap, reusable, for use in a tracheostoma heat and moisture exchange system, each |
417 |
417 |
$23K |
| A7002 |
Tubing, used with suction pump, each |
2,274 |
2,274 |
$16K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
342 |
341 |
$15K |
| A4245 |
Alcohol wipes, per box |
1,226 |
1,226 |
$13K |
| E0570 |
Nebulizer, with compressor |
114 |
114 |
$12K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,051 |
1,051 |
$9K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
2,414 |
2,413 |
$9K |
| A4402 |
Lubricant, per ounce |
801 |
801 |
$6K |
| A6453 |
Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard |
296 |
296 |
$6K |
| A4208 |
Syringe with needle, sterile 3 cc, each |
602 |
602 |
$5K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
661 |
661 |
$4K |
| A6260 |
Wound cleansers, any type, any size |
1,563 |
1,563 |
$4K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
96 |
96 |
$2K |
| A7525 |
Tracheostomy mask, each |
227 |
227 |
$2K |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
294 |
294 |
$893.97 |
| A4206 |
Syringe with needle, sterile, 1 cc or less, each |
12 |
12 |
$325.00 |
| A7015 |
Aerosol mask, used with dme nebulizer |
197 |
197 |
$273.81 |