| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
815 |
724 |
$134K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
521 |
487 |
$98K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
1,444 |
814 |
$76K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
1,196 |
1,169 |
$73K |
| B9998 |
Noc for enteral supplies |
1,408 |
1,041 |
$69K |
| A4554 |
Disposable underpads, all sizes |
868 |
832 |
$63K |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
308 |
305 |
$47K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,210 |
1,161 |
$22K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
669 |
643 |
$20K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,161 |
1,142 |
$12K |
| A7526 |
Tracheostomy tube collar/holder, each |
665 |
629 |
$11K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
207 |
193 |
$11K |
| A7002 |
Tubing, used with suction pump, each |
1,221 |
1,175 |
$10K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
2,279 |
836 |
$5K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
724 |
674 |
$4K |
| A4335 |
Incontinence supply; miscellaneous |
962 |
888 |
$4K |
| A4322 |
Irrigation syringe, bulb or piston, each |
959 |
918 |
$4K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
91 |
89 |
$4K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
1,315 |
1,251 |
$3K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,062 |
980 |
$2K |
| 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 |
12 |
12 |
$2K |
| B9002 |
Enteral nutrition infusion pump, any type |
26 |
25 |
$2K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
98 |
98 |
$760.84 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
583 |
546 |
$725.43 |
| A4927 |
Gloves, non-sterile, per 100 |
631 |
606 |
$660.06 |
| A4481 |
Tracheostoma filter, any type, any size, each |
41 |
38 |
$103.87 |