| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
982 |
793 |
$334K |
| A4554 |
Disposable underpads, all sizes |
3,107 |
3,098 |
$255K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
1,093 |
1,046 |
$197K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,392 |
2,384 |
$183K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
1,395 |
1,372 |
$91K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
404 |
404 |
$66K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
1,590 |
1,587 |
$57K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
374 |
372 |
$56K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
482 |
482 |
$55K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
328 |
327 |
$47K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,488 |
2,468 |
$47K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,072 |
1,061 |
$24K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,652 |
1,622 |
$21K |
| A4927 |
Gloves, non-sterile, per 100 |
2,543 |
2,533 |
$11K |
| A4217 |
Sterile water/saline, 500 ml |
458 |
453 |
$5K |
| A7002 |
Tubing, used with suction pump, each |
1,620 |
1,594 |
$4K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
769 |
751 |
$4K |
| A7526 |
Tracheostomy tube collar/holder, each |
83 |
80 |
$2K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
50 |
49 |
$2K |
| A4623 |
Tracheostomy, inner cannula |
41 |
38 |
$2K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
12 |
12 |
$1K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
65 |
60 |
$982.35 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
274 |
232 |
$704.87 |