| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
23,890 |
13,995 |
$30.19M |
| 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 |
46,683 |
32,088 |
$24.54M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
66,090 |
61,635 |
$19.52M |
| 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 |
30,424 |
23,195 |
$16.90M |
| 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 |
44,425 |
34,282 |
$10.99M |
| B9998 |
Noc for enteral supplies |
97,242 |
60,373 |
$10.19M |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
5,293 |
4,227 |
$7.68M |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
48,792 |
42,130 |
$6.60M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
4,652 |
3,690 |
$6.29M |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
34,976 |
28,727 |
$4.81M |
| A4217 |
Sterile water/saline, 500 ml |
27,521 |
21,226 |
$3.89M |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
17,999 |
15,929 |
$3.83M |
| B9002 |
Enteral nutrition infusion pump, any type |
22,852 |
20,869 |
$2.81M |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
10,992 |
8,702 |
$2.71M |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
6,820 |
4,944 |
$2.39M |
| 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 |
8,395 |
6,503 |
$2.34M |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
13,609 |
12,483 |
$2.21M |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
11,312 |
9,647 |
$2.06M |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
8,393 |
7,593 |
$1.81M |
| A4605 |
Tracheal suction catheter, closed system, each |
4,021 |
3,664 |
$1.66M |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
11,703 |
10,010 |
$1.64M |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
8,795 |
6,821 |
$1.41M |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
9,192 |
7,788 |
$1.31M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
9,347 |
8,368 |
$1.20M |
| 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 |
4,563 |
3,654 |
$1.20M |
| E0482 |
Cough stimulating device, alternating positive and negative airway pressure |
1,974 |
1,623 |
$1.18M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
8,927 |
7,721 |
$1.15M |
| A7526 |
Tracheostomy tube collar/holder, each |
12,706 |
11,489 |
$1.13M |
| 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 |
1,957 |
1,474 |
$1.05M |
| A4927 |
Gloves, non-sterile, per 100 |
38,545 |
33,701 |
$1.03M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
19,433 |
16,921 |
$1.01M |
| T4541 |
Incontinence product, disposable underpad, large, each |
21,673 |
19,848 |
$984K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
3,520 |
2,916 |
$977K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
53,636 |
24,507 |
$977K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,875 |
4,264 |
$938K |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
1,265 |
1,113 |
$915K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
6,597 |
6,477 |
$857K |
| E1399 |
Durable medical equipment, miscellaneous |
3,235 |
3,046 |
$820K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
9,900 |
8,628 |
$644K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
4,744 |
3,944 |
$556K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
4,548 |
4,203 |
$555K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
3,656 |
3,320 |
$555K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
5,468 |
4,516 |
$501K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
25,185 |
22,598 |
$479K |
| B4158 |
Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
2,876 |
2,202 |
$468K |
| 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) |
1,668 |
1,559 |
$451K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
13,231 |
11,849 |
$449K |
| A6210 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
1,282 |
1,044 |
$437K |
| A7001 |
Canister, non-disposable, used with suction pump, each |
13,519 |
12,356 |
$419K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
3,199 |
2,736 |
$411K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
2,673 |
2,423 |
$410K |
| A4657 |
Syringe, with or without needle, each |
45,801 |
38,509 |
$383K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
475 |
395 |
$378K |
| A4453 |
Rectal catheter with or without balloon, for use with any type transanal irrigation system, each |
875 |
619 |
$361K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
7,758 |
6,765 |
$357K |
| A4322 |
Irrigation syringe, bulb or piston, each |
9,820 |
6,764 |
$338K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
2,812 |
2,326 |
$317K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,668 |
1,598 |
$309K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
18,239 |
16,027 |
$304K |
| K0462 |
Temporary replacement for patient owned equipment being repaired, any type |
2,256 |
2,131 |
$277K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,084 |
1,896 |
$267K |
| L8501 |
Tracheostomy speaking valve |
1,531 |
1,395 |
$239K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,862 |
1,687 |
$221K |
| A7008 |
Large volume nebulizer, disposable, prefilled, used with aerosol compressor |
1,919 |
1,643 |
$215K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
2,763 |
2,511 |
$190K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
5,569 |
5,258 |
$183K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,009 |
929 |
$178K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
3,689 |
3,440 |
$171K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
6,773 |
6,212 |
$170K |
| B4162 |
Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
485 |
340 |
$169K |
| A4218 |
Sterile saline or water, metered dose dispenser, 10 ml |
9,500 |
8,166 |
$163K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
15,515 |
14,090 |
$153K |
| E0776 |
Iv pole |
1,422 |
1,264 |
$146K |
| A7002 |
Tubing, used with suction pump, each |
19,953 |
18,059 |
$143K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
1,970 |
1,618 |
$140K |
| A7000 |
Canister, disposable, used with suction pump, each |
8,816 |
8,137 |
$137K |
| S8189 |
Tracheostomy supply, not otherwise classified |
12,720 |
9,753 |
$135K |
| A4332 |
Lubricant, individual sterile packet, each |
6,579 |
6,046 |
$113K |
| A4456 |
Adhesive remover, wipes, any type, each |
5,859 |
5,147 |
$100K |
| A7020 |
Interface for cough stimulating device, includes all components, replacement only |
5,247 |
5,055 |
$95K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,830 |
1,702 |
$90K |
| A4452 |
Tape, waterproof, per 18 square inches |
12,357 |
11,246 |
$90K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
1,199 |
954 |
$88K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
637 |
590 |
$82K |
| A7035 |
Headgear used with positive airway pressure device |
2,753 |
2,409 |
$74K |
| A4421 |
Ostomy supply; miscellaneous |
475 |
334 |
$73K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
339 |
299 |
$65K |
| A5120 |
Skin barrier, wipes or swabs, each |
4,993 |
4,463 |
$63K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
574 |
429 |
$60K |
| A4623 |
Tracheostomy, inner cannula |
283 |
240 |
$60K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,233 |
3,735 |
$49K |
| E0570 |
Nebulizer, with compressor |
635 |
612 |
$45K |
| A4245 |
Alcohol wipes, per box |
8,297 |
7,875 |
$45K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
457 |
347 |
$43K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
720 |
490 |
$43K |
| A7015 |
Aerosol mask, used with dme nebulizer |
8,894 |
8,026 |
$43K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
714 |
668 |
$41K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
759 |
657 |
$30K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
610 |
598 |
$28K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
873 |
815 |
$28K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
567 |
449 |
$27K |
| A6213 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
125 |
99 |
$26K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
1,348 |
1,243 |
$24K |
| A7030 |
Full face mask used with positive airway pressure device, each |
221 |
194 |
$23K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
107 |
99 |
$23K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
293 |
232 |
$23K |
| E0619 |
Apnea monitor, with recording feature |
109 |
99 |
$22K |
| S8186 |
Swivel adapter |
2,751 |
2,560 |
$21K |
| A7037 |
Tubing used with positive airway pressure device |
1,838 |
1,568 |
$20K |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
167 |
123 |
$19K |
| B4100 |
Food thickener, administered orally, per ounce |
625 |
496 |
$18K |
| A4209 |
Syringe with needle, sterile 5 cc or greater, each |
2,663 |
2,290 |
$18K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
4,098 |
3,847 |
$18K |
| A7525 |
Tracheostomy mask, each |
5,688 |
5,080 |
$17K |
| A4618 |
Breathing circuits |
1,170 |
1,044 |
$16K |
| E0565 |
Compressor, air power source for equipment which is not self-contained or cylinder driven |
207 |
182 |
$15K |
| S8999 |
Resuscitation bag (for use by patient on artificial respiration during power failure or other catastrophic event) |
449 |
381 |
$15K |
| A4930 |
Gloves, sterile, per pair |
329 |
278 |
$14K |
| S8120 |
Oxygen contents, gaseous, 1 unit equals 1 cubic foot |
764 |
531 |
$14K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
3,324 |
3,054 |
$13K |
| B4082 |
Nasogastric tubing without stylet |
348 |
258 |
$12K |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
6,704 |
6,281 |
$11K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
94 |
82 |
$8K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
327 |
268 |
$7K |
| A4402 |
Lubricant, per ounce |
844 |
760 |
$6K |
| K0003 |
Lightweight wheelchair |
119 |
111 |
$6K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
326 |
268 |
$5K |
| A4335 |
Incontinence supply; miscellaneous |
105 |
99 |
$5K |
| A4371 |
Ostomy skin barrier, powder, per oz |
477 |
432 |
$4K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
81 |
80 |
$4K |
| A4554 |
Disposable underpads, all sizes |
189 |
164 |
$3K |
| A4458 |
Enema bag with tubing, reusable |
722 |
625 |
$3K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
87 |
68 |
$3K |
| A4250 |
Urine test or reagent strips or tablets (100 tablets or strips) |
212 |
187 |
$2K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
13 |
12 |
$2K |
| A7045 |
Exhalation port with or without swivel used with accessories for positive airway devices, replacement only |
193 |
170 |
$2K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
95 |
88 |
$1K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
139 |
112 |
$894.89 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
256 |
252 |
$841.51 |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
74 |
71 |
$680.08 |
| A6260 |
Wound cleansers, any type, any size |
46 |
41 |
$636.45 |
| E0190 |
Positioning cushion/pillow/wedge, any shape or size, includes all components and accessories |
33 |
27 |
$567.13 |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
47 |
39 |
$484.09 |
| A4244 |
Alcohol or peroxide, per pint |
120 |
99 |
$472.78 |
| A4206 |
Syringe with needle, sterile, 1 cc or less, each |
117 |
100 |
$417.64 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
90 |
87 |
$322.37 |
| A7527 |
Tracheostomy/laryngectomy tube plug/stop, each |
48 |
43 |
$283.78 |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
15 |
13 |
$129.96 |
| A7014 |
Filter, nondisposable, used with aerosol compressor or ultrasonic generator |
14 |
13 |
$30.19 |
| S8210 |
Mucus trap |
13 |
12 |
$17.34 |
| A4626 |
Tracheostomy cleaning brush, each |
26 |
24 |
$2.50 |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
483 |
156 |
$0.00 |
| S9999 |
Sales tax |
415 |
350 |
$0.00 |