| 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 |
10,163 |
9,183 |
$560K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,104 |
1,752 |
$241K |
| 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 |
906 |
827 |
$143K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
6,106 |
5,578 |
$135K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,403 |
1,348 |
$62K |
| B9998 |
Noc for enteral supplies |
667 |
590 |
$45K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,994 |
2,782 |
$37K |
| 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 |
371 |
322 |
$30K |
| E0601 |
Continuous positive airway pressure (cpap) device |
760 |
696 |
$25K |
| A7030 |
Full face mask used with positive airway pressure device, each |
249 |
231 |
$22K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
631 |
603 |
$11K |
| E0570 |
Nebulizer, with compressor |
3,119 |
2,653 |
$11K |
| 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 |
123 |
106 |
$8K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
139 |
137 |
$7K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
134 |
128 |
$6K |
| B9002 |
Enteral nutrition infusion pump, any type |
121 |
107 |
$5K |
| A7035 |
Headgear used with positive airway pressure device |
209 |
198 |
$4K |
| K0738 |
Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing |
170 |
169 |
$4K |
| A7037 |
Tubing used with positive airway pressure device |
140 |
132 |
$3K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
42 |
42 |
$2K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
88 |
84 |
$1K |
| E1392 |
Portable oxygen concentrator, rental |
59 |
55 |
$897.39 |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
13 |
13 |
$873.50 |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
13 |
12 |
$395.11 |
| E0776 |
Iv pole |
27 |
26 |
$267.02 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
136 |
102 |
$156.36 |