| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
453 |
394 |
$317K |
| 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 |
700 |
637 |
$252K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
945 |
894 |
$236K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
274 |
251 |
$148K |
| B9998 |
Noc for enteral supplies |
798 |
762 |
$137K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
611 |
581 |
$135K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
602 |
587 |
$104K |
| 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 |
369 |
342 |
$97K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
1,033 |
994 |
$84K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
499 |
420 |
$72K |
| B9002 |
Enteral nutrition infusion pump, any type |
778 |
750 |
$50K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
607 |
580 |
$29K |
| A4927 |
Gloves, non-sterile, per 100 |
808 |
785 |
$27K |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
1,287 |
1,242 |
$26K |
| A4554 |
Disposable underpads, all sizes |
508 |
496 |
$23K |
| A5200 |
Percutaneous catheter/tube anchoring device, adhesive skin attachment |
227 |
224 |
$22K |
| 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 |
552 |
537 |
$20K |
| A4553 |
Non-disposable underpads, all sizes |
282 |
278 |
$16K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
292 |
268 |
$15K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
102 |
99 |
$12K |
| B4100 |
Food thickener, administered orally, per ounce |
117 |
105 |
$11K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
14 |
12 |
$10K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
228 |
222 |
$10K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
390 |
372 |
$9K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
699 |
678 |
$9K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
57 |
54 |
$6K |
| A7000 |
Canister, disposable, used with suction pump, each |
352 |
339 |
$6K |
| B4104 |
Additive for enteral formula (e.g., fiber) |
52 |
51 |
$6K |
| A4452 |
Tape, waterproof, per 18 square inches |
648 |
613 |
$5K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
366 |
360 |
$5K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
26 |
25 |
$4K |
| A5120 |
Skin barrier, wipes or swabs, each |
310 |
296 |
$3K |
| A6453 |
Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard |
294 |
286 |
$2K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
145 |
131 |
$2K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
12 |
12 |
$2K |
| A4456 |
Adhesive remover, wipes, any type, each |
180 |
176 |
$2K |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
14 |
12 |
$2K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
44 |
44 |
$1K |
| A4245 |
Alcohol wipes, per box |
83 |
83 |
$814.75 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
227 |
222 |
$748.01 |
| A4322 |
Irrigation syringe, bulb or piston, each |
13 |
13 |
$632.00 |
| A7015 |
Aerosol mask, used with dme nebulizer |
133 |
132 |
$166.46 |
| A4332 |
Lubricant, individual sterile packet, each |
26 |
25 |
$45.76 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
12 |
12 |
$34.57 |