| 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 |
200 |
196 |
$22K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
40 |
39 |
$18K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
119 |
119 |
$13K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
306 |
205 |
$12K |
| A7526 |
Tracheostomy tube collar/holder, each |
83 |
83 |
$7K |
| A4554 |
Disposable underpads, all sizes |
211 |
210 |
$5K |
| A4927 |
Gloves, non-sterile, per 100 |
263 |
261 |
$4K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
141 |
139 |
$3K |
| A4217 |
Sterile water/saline, 500 ml |
76 |
75 |
$3K |
| A7000 |
Canister, disposable, used with suction pump, each |
150 |
148 |
$3K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
123 |
121 |
$2K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
90 |
89 |
$1K |
| A7002 |
Tubing, used with suction pump, each |
142 |
141 |
$1K |
| A4657 |
Syringe, with or without needle, each |
134 |
131 |
$710.60 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
170 |
169 |
$542.72 |
| A7018 |
Water, distilled, used with large volume nebulizer, 1000 ml |
116 |
115 |
$291.20 |
| A4245 |
Alcohol wipes, per box |
24 |
24 |
$62.95 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
77 |
76 |
$25.24 |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
27 |
25 |
$0.00 |
| 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 |
97 |
87 |
$0.00 |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
30 |
30 |
$0.00 |
| A7014 |
Filter, nondisposable, used with aerosol compressor or ultrasonic generator |
58 |
58 |
$0.00 |
| A4335 |
Incontinence supply; miscellaneous |
180 |
178 |
$0.00 |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
57 |
54 |
$0.00 |