| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
3,101 |
3,061 |
$2.74M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
8,600 |
8,532 |
$2.68M |
| 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 |
3,335 |
3,309 |
$1.23M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
1,219 |
1,188 |
$1.09M |
| B9998 |
Noc for enteral supplies |
11,738 |
9,858 |
$1.01M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
5,488 |
5,466 |
$715K |
| 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 |
917 |
909 |
$466K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
8,068 |
3,423 |
$422K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
1,981 |
1,963 |
$341K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
1,014 |
1,005 |
$269K |
| B9002 |
Enteral nutrition infusion pump, any type |
2,771 |
2,725 |
$268K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
276 |
242 |
$250K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
2,018 |
1,940 |
$246K |
| A4605 |
Tracheal suction catheter, closed system, each |
911 |
814 |
$163K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
6,502 |
6,418 |
$150K |
| A4554 |
Disposable underpads, all sizes |
5,294 |
5,105 |
$141K |
| A7000 |
Canister, disposable, used with suction pump, each |
4,634 |
4,584 |
$139K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
765 |
748 |
$133K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
1,215 |
1,165 |
$120K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
797 |
788 |
$87K |
| A4322 |
Irrigation syringe, bulb or piston, each |
9,329 |
9,163 |
$86K |
| A7526 |
Tracheostomy tube collar/holder, each |
2,213 |
2,158 |
$83K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
757 |
752 |
$82K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
1,677 |
1,655 |
$78K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
9,955 |
9,041 |
$74K |
| A4927 |
Gloves, non-sterile, per 100 |
8,888 |
8,838 |
$62K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
549 |
488 |
$58K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
471 |
458 |
$56K |
| A7002 |
Tubing, used with suction pump, each |
4,564 |
4,537 |
$52K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
1,435 |
1,405 |
$30K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
4,340 |
4,250 |
$28K |
| A4335 |
Incontinence supply; miscellaneous |
5,438 |
5,387 |
$27K |
| A4332 |
Lubricant, individual sterile packet, each |
5,294 |
5,266 |
$19K |
| A4217 |
Sterile water/saline, 500 ml |
5,316 |
5,289 |
$15K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
9,118 |
9,077 |
$15K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
3,352 |
3,327 |
$13K |
| E0776 |
Iv pole |
1,561 |
1,547 |
$12K |
| A4245 |
Alcohol wipes, per box |
6,725 |
6,697 |
$12K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
91 |
85 |
$9K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
1,426 |
1,177 |
$7K |
| A4244 |
Alcohol or peroxide, per pint |
7,107 |
7,080 |
$6K |
| A7525 |
Tracheostomy mask, each |
1,720 |
1,047 |
$4K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
276 |
265 |
$3K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
24 |
24 |
$2K |
| L8501 |
Tracheostomy speaking valve |
13 |
13 |
$814.64 |
| A4402 |
Lubricant, per ounce |
389 |
386 |
$521.16 |