| 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 |
8,503 |
8,095 |
$186K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
5,746 |
5,500 |
$22K |
| A7030 |
Full face mask used with positive airway pressure device, each |
438 |
435 |
$9K |
| A7031 |
Face mask interface, replacement for full face mask, each |
563 |
531 |
$7K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,162 |
1,126 |
$5K |
| K0001 |
Standard wheelchair |
366 |
341 |
$4K |
| E0470 |
Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
550 |
534 |
$3K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
342 |
341 |
$3K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
558 |
524 |
$2K |
| A7035 |
Headgear used with positive airway pressure device |
503 |
496 |
$2K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
141 |
130 |
$2K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,432 |
1,370 |
$2K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
80 |
78 |
$2K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
104 |
104 |
$1K |
| 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 |
127 |
99 |
$1K |
| A7037 |
Tubing used with positive airway pressure device |
313 |
312 |
$836.31 |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
39 |
39 |
$334.39 |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
314 |
296 |
$202.51 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
236 |
236 |
$163.41 |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
27 |
24 |
$64.94 |
| E1392 |
Portable oxygen concentrator, rental |
216 |
212 |
$61.14 |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
24 |
24 |
$0.00 |
| E0471 |
Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
12 |
12 |
$0.00 |
| B9002 |
Enteral nutrition infusion pump, any type |
14 |
14 |
$0.00 |