| 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 |
3,160 |
2,455 |
$1.51M |
| 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 |
3,181 |
2,677 |
$640K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
4,298 |
3,871 |
$317K |
| E0601 |
Continuous positive airway pressure (cpap) device |
5,221 |
4,738 |
$195K |
| A7030 |
Full face mask used with positive airway pressure device, each |
2,181 |
1,957 |
$166K |
| E0570 |
Nebulizer, with compressor |
4,394 |
3,916 |
$164K |
| 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 |
508 |
426 |
$100K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
4,112 |
3,743 |
$67K |
| E1150 |
Wheelchair, detachable arms, desk or full length swing away detachable elevating legrests |
1,419 |
1,236 |
$62K |
| A7031 |
Face mask interface, replacement for full face mask, each |
2,086 |
1,864 |
$59K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
4,545 |
4,117 |
$55K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,284 |
1,100 |
$39K |
| A7035 |
Headgear used with positive airway pressure device |
1,918 |
1,756 |
$30K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
980 |
860 |
$30K |
| A7037 |
Tubing used with positive airway pressure device |
2,410 |
2,178 |
$29K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
5,635 |
5,090 |
$20K |
| E0202 |
Phototherapy (bilirubin) light with photometer |
343 |
59 |
$12K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
900 |
812 |
$10K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
2,792 |
2,551 |
$7K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
149 |
129 |
$7K |
| E1240 |
Lightweight wheelchair, detachable arms, (desk or full length) swing away detachable, elevating legrest |
119 |
110 |
$6K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
442 |
370 |
$6K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
35 |
27 |
$6K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
55 |
37 |
$5K |
| B9998 |
Noc for enteral supplies |
82 |
64 |
$4K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
33 |
26 |
$3K |
| K0001 |
Standard wheelchair |
568 |
478 |
$3K |
| A7015 |
Aerosol mask, used with dme nebulizer |
2,207 |
2,041 |
$2K |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
2,305 |
2,103 |
$2K |
| E1280 |
Heavy duty wheelchair, detachable arms (desk or full length) elevating legrests |
13 |
12 |
$2K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
29 |
26 |
$1K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
12 |
12 |
$238.72 |