| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
1,788 |
1,378 |
$359K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,693 |
2,526 |
$240K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,114 |
1,904 |
$205K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,494 |
1,388 |
$141K |
| B9998 |
Noc for enteral supplies |
1,107 |
927 |
$141K |
| 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 |
1,179 |
1,011 |
$59K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
964 |
840 |
$57K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
716 |
669 |
$57K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,534 |
1,393 |
$55K |
| 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) |
198 |
186 |
$50K |
| A7037 |
Tubing used with positive airway pressure device |
1,937 |
1,808 |
$44K |
| 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 |
741 |
621 |
$44K |
| 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 |
486 |
434 |
$32K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
415 |
375 |
$30K |
| E0570 |
Nebulizer, with compressor |
997 |
912 |
$29K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,174 |
927 |
$27K |
| A7035 |
Headgear used with positive airway pressure device |
1,182 |
1,092 |
$25K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
326 |
312 |
$21K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
385 |
363 |
$14K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,960 |
1,826 |
$11K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
1,174 |
1,085 |
$9K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
454 |
418 |
$7K |
| A7000 |
Canister, disposable, used with suction pump, each |
818 |
718 |
$6K |
| K0001 |
Standard wheelchair |
423 |
395 |
$5K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
35 |
26 |
$5K |
| A7002 |
Tubing, used with suction pump, each |
821 |
715 |
$4K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
946 |
617 |
$4K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
773 |
668 |
$4K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
129 |
123 |
$4K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
876 |
801 |
$4K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
63 |
48 |
$3K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
194 |
176 |
$2K |
| B9002 |
Enteral nutrition infusion pump, any type |
78 |
67 |
$2K |
| A7015 |
Aerosol mask, used with dme nebulizer |
556 |
498 |
$1K |
| A7526 |
Tracheostomy tube collar/holder, each |
81 |
73 |
$423.74 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
12 |
12 |
$18.86 |