| 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 |
250,086 |
13,814 |
$2.37M |
| B9998 |
Noc for enteral supplies |
29,307 |
13,352 |
$1.42M |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
17,130 |
13,615 |
$1.17M |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
2,079 |
1,579 |
$1.01M |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
1,861 |
1,392 |
$872K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
6,862 |
4,184 |
$834K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
21,095 |
6,086 |
$618K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
8,347 |
4,885 |
$569K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
8,084 |
6,441 |
$556K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
41,709 |
7,190 |
$420K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
56,372 |
4,429 |
$399K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
3,815 |
2,010 |
$355K |
| E2402 |
Negative pressure wound therapy electrical pump, stationary or portable |
978 |
677 |
$327K |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
898 |
426 |
$326K |
| B9002 |
Enteral nutrition infusion pump, any type |
588 |
465 |
$284K |
| A7526 |
Tracheostomy tube collar/holder, each |
3,622 |
2,832 |
$274K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
32,735 |
2,811 |
$262K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
45,807 |
3,577 |
$255K |
| E1150 |
Wheelchair, detachable arms, desk or full length swing away detachable elevating legrests |
6,142 |
3,819 |
$245K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
33,525 |
2,106 |
$208K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,413 |
1,098 |
$204K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
2,694 |
2,053 |
$201K |
| A4217 |
Sterile water/saline, 500 ml |
2,630 |
2,191 |
$145K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
11,809 |
9,172 |
$144K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
13,224 |
1,156 |
$139K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
5,637 |
1,518 |
$137K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
211 |
162 |
$133K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
21,576 |
1,343 |
$124K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
7,561 |
3,908 |
$114K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
13,251 |
1,261 |
$112K |
| E0443 |
Portable oxygen contents, gaseous, 1 month's supply = 1 unit |
2,114 |
1,279 |
$103K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
1,038 |
662 |
$100K |
| A7000 |
Canister, disposable, used with suction pump, each |
10,751 |
7,996 |
$100K |
| E0570 |
Nebulizer, with compressor |
1,933 |
1,597 |
$98K |
| A7507 |
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each |
4,639 |
1,214 |
$97K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
3,300 |
1,845 |
$92K |
| E1060 |
Fully-reclining wheelchair, detachable arms, desk or full length, swing away detachable elevating legrests |
1,119 |
942 |
$89K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
13,212 |
740 |
$82K |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
2,011 |
1,029 |
$80K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
2,503 |
1,671 |
$76K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
1,256 |
604 |
$62K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
2,614 |
1,828 |
$61K |
| A6550 |
Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories |
1,101 |
457 |
$59K |
| E1140 |
Wheelchair, detachable arms, desk or full length, swing away detachable footrests |
548 |
485 |
$59K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
6,218 |
640 |
$58K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
3,878 |
3,136 |
$52K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
72 |
29 |
$50K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,188 |
999 |
$47K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
2,696 |
1,068 |
$39K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
2,056 |
1,219 |
$35K |
| K0001 |
Standard wheelchair |
4,269 |
3,392 |
$33K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
1,677 |
1,174 |
$33K |
| A7002 |
Tubing, used with suction pump, each |
9,875 |
7,568 |
$32K |
| A4554 |
Disposable underpads, all sizes |
11,657 |
1,237 |
$31K |
| E0776 |
Iv pole |
447 |
337 |
$30K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
188 |
163 |
$25K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
3,940 |
233 |
$22K |
| A7525 |
Tracheostomy mask, each |
2,965 |
2,137 |
$18K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,360 |
1,885 |
$18K |
| A4402 |
Lubricant, per ounce |
3,254 |
2,656 |
$15K |
| A4322 |
Irrigation syringe, bulb or piston, each |
1,193 |
518 |
$15K |
| A7010 |
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet |
1,299 |
1,048 |
$14K |
| A4209 |
Syringe with needle, sterile 5 cc or greater, each |
1,993 |
1,527 |
$10K |
| A4305 |
Disposable drug delivery system, flow rate of 50 ml or greater per hour |
154 |
27 |
$9K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
400 |
347 |
$9K |
| A4623 |
Tracheostomy, inner cannula |
477 |
294 |
$9K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
3,628 |
2,387 |
$7K |
| A4927 |
Gloves, non-sterile, per 100 |
1,543 |
1,059 |
$7K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
3,327 |
2,935 |
$6K |
| A7015 |
Aerosol mask, used with dme nebulizer |
5,366 |
4,514 |
$6K |
| A7007 |
Large volume nebulizer, disposable, unfilled, used with aerosol compressor |
2,166 |
1,699 |
$5K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
45 |
27 |
$4K |
| A4605 |
Tracheal suction catheter, closed system, each |
20 |
12 |
$4K |
| A7012 |
Water collection device, used with large volume nebulizer |
1,981 |
1,511 |
$4K |
| E0184 |
Dry pressure mattress |
67 |
52 |
$4K |
| 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 |
150 |
107 |
$3K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
324 |
148 |
$3K |
| E1092 |
Wide heavy duty wheel chair, detachable arms (desk or full length), swing away detachable elevating leg rests |
15 |
13 |
$3K |
| 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 |
429 |
396 |
$2K |
| 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 |
50 |
39 |
$2K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
2,180 |
939 |
$2K |
| A4244 |
Alcohol or peroxide, per pint |
666 |
587 |
$2K |
| K0003 |
Lightweight wheelchair |
315 |
212 |
$2K |
| K0006 |
Heavy duty wheelchair |
200 |
164 |
$2K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
282 |
12 |
$1K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
898 |
713 |
$1K |
| E0601 |
Continuous positive airway pressure (cpap) device |
37 |
24 |
$972.76 |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
106 |
86 |
$787.19 |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
59 |
50 |
$529.64 |
| 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 |
83 |
72 |
$508.95 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
96 |
53 |
$474.01 |
| 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 |
18 |
12 |
$365.23 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
216 |
153 |
$342.73 |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
721 |
336 |
$208.43 |
| 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 |
28 |
24 |
$0.00 |