| 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 |
1,932 |
1,575 |
$212K |
| 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 |
1,009 |
792 |
$173K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
1,675 |
1,357 |
$121K |
| B9998 |
Noc for enteral supplies |
3,673 |
2,099 |
$120K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,462 |
2,105 |
$97K |
| A4217 |
Sterile water/saline, 500 ml |
1,297 |
929 |
$88K |
| A7526 |
Tracheostomy tube collar/holder, each |
917 |
735 |
$50K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
619 |
472 |
$49K |
| E1399 |
Durable medical equipment, miscellaneous |
4,786 |
1,788 |
$42K |
| S8189 |
Tracheostomy supply, not otherwise classified |
908 |
465 |
$41K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
410 |
387 |
$35K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,718 |
2,319 |
$27K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,964 |
1,637 |
$27K |
| A7000 |
Canister, disposable, used with suction pump, each |
1,585 |
1,268 |
$21K |
| 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 |
45 |
38 |
$19K |
| A4452 |
Tape, waterproof, per 18 square inches |
1,012 |
831 |
$16K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
946 |
787 |
$15K |
| A7002 |
Tubing, used with suction pump, each |
1,439 |
1,125 |
$15K |
| A4927 |
Gloves, non-sterile, per 100 |
1,106 |
941 |
$13K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
411 |
337 |
$12K |
| B9002 |
Enteral nutrition infusion pump, any type |
226 |
207 |
$12K |
| A4618 |
Breathing circuits |
489 |
360 |
$9K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
1,467 |
1,264 |
$8K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
79 |
61 |
$7K |
| B4082 |
Nasogastric tubing without stylet |
146 |
107 |
$5K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
35 |
25 |
$4K |
| A4210 |
Needle-free injection device, each |
928 |
754 |
$4K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
165 |
114 |
$3K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
124 |
122 |
$3K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
61 |
51 |
$2K |
| E0776 |
Iv pole |
179 |
165 |
$2K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
50 |
37 |
$2K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
117 |
94 |
$2K |
| E1405 |
Oxygen and water vapor enriching system with heated delivery |
13 |
12 |
$372.00 |
| A7004 |
Small volume nonfiltered pneumatic nebulizer, disposable |
152 |
100 |
$339.71 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
99 |
75 |
$299.31 |
| A4402 |
Lubricant, per ounce |
32 |
29 |
$208.93 |
| A4245 |
Alcohol wipes, per box |
63 |
49 |
$159.68 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
95 |
78 |
$93.05 |
| A4616 |
Tubing (oxygen), per foot |
47 |
37 |
$55.93 |
| A7525 |
Tracheostomy mask, each |
13 |
12 |
$42.73 |