| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,112 |
2,584 |
$726K |
| B9998 |
Noc for enteral supplies |
4,040 |
2,783 |
$465K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
8,937 |
7,778 |
$404K |
| 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 |
457 |
280 |
$265K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
3,966 |
2,914 |
$200K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
1,695 |
873 |
$167K |
| 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 |
561 |
404 |
$139K |
| E0601 |
Continuous positive airway pressure (cpap) device |
3,812 |
3,384 |
$134K |
| E0570 |
Nebulizer, with compressor |
1,308 |
1,259 |
$125K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
1,892 |
1,665 |
$118K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
7,870 |
1,964 |
$107K |
| B9002 |
Enteral nutrition infusion pump, any type |
609 |
521 |
$88K |
| 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 |
3,093 |
2,679 |
$74K |
| A7031 |
Face mask interface, replacement for full face mask, each |
3,072 |
2,667 |
$74K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
401 |
333 |
$57K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,110 |
886 |
$52K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
4,636 |
4,046 |
$51K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
634 |
575 |
$50K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,312 |
1,151 |
$48K |
| A7526 |
Tracheostomy tube collar/holder, each |
759 |
638 |
$46K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,080 |
914 |
$46K |
| A7037 |
Tubing used with positive airway pressure device |
4,281 |
3,905 |
$37K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
923 |
797 |
$31K |
| A7000 |
Canister, disposable, used with suction pump, each |
2,396 |
2,126 |
$31K |
| A7508 |
Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, each |
152 |
136 |
$20K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
195 |
172 |
$19K |
| A7035 |
Headgear used with positive airway pressure device |
1,656 |
1,433 |
$18K |
| K0001 |
Standard wheelchair |
1,397 |
1,167 |
$18K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
4,904 |
4,222 |
$14K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,291 |
1,202 |
$13K |
| A7002 |
Tubing, used with suction pump, each |
2,409 |
2,138 |
$12K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
865 |
751 |
$11K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
641 |
573 |
$9K |
| 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 |
40 |
26 |
$8K |
| E1399 |
Durable medical equipment, miscellaneous |
16 |
12 |
$8K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
55 |
49 |
$7K |
| A4452 |
Tape, waterproof, per 18 square inches |
874 |
749 |
$6K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
164 |
145 |
$5K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
843 |
745 |
$4K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
314 |
276 |
$3K |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
590 |
521 |
$2K |
| E0776 |
Iv pole |
124 |
104 |
$2K |
| A7015 |
Aerosol mask, used with dme nebulizer |
1,495 |
1,433 |
$2K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
27 |
25 |
$1K |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
1,137 |
1,095 |
$1K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
122 |
102 |
$811.64 |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
13 |
12 |
$540.56 |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
15 |
13 |
$321.42 |
| A7525 |
Tracheostomy mask, each |
137 |
124 |
$179.36 |
| A7012 |
Water collection device, used with large volume nebulizer |
43 |
36 |
$170.85 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
75 |
71 |
$124.03 |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
15 |
12 |
$55.04 |