| 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 |
2,341 |
2,163 |
$136K |
| 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 |
328 |
261 |
$109K |
| 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 |
991 |
829 |
$75K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
965 |
776 |
$74K |
| 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 |
764 |
648 |
$48K |
| E0441 |
Stationary oxygen contents, gaseous, 1 month's supply = 1 unit |
793 |
643 |
$26K |
| E0439 |
Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing |
395 |
374 |
$25K |
| 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 |
73 |
63 |
$18K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,218 |
1,116 |
$16K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
231 |
199 |
$8K |
| E0442 |
Stationary oxygen contents, liquid, 1 month's supply = 1 unit |
329 |
222 |
$7K |
| A7037 |
Tubing used with positive airway pressure device |
285 |
269 |
$5K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
31 |
25 |
$5K |
| E0434 |
Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing |
290 |
263 |
$5K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
170 |
120 |
$3K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
31 |
29 |
$3K |
| E0601 |
Continuous positive airway pressure (cpap) device |
42 |
42 |
$1K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
317 |
293 |
$838.99 |
| A7030 |
Full face mask used with positive airway pressure device, each |
14 |
12 |
$565.27 |
| A7035 |
Headgear used with positive airway pressure device |
28 |
24 |
$447.19 |
| B9002 |
Enteral nutrition infusion pump, any type |
28 |
27 |
$402.93 |
| E0776 |
Iv pole |
247 |
246 |
$384.12 |
| A7031 |
Face mask interface, replacement for full face mask, each |
14 |
12 |
$343.74 |