| 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 |
90 |
89 |
$12K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
13 |
13 |
$7K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
163 |
99 |
$7K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
41 |
41 |
$6K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
55 |
55 |
$2K |
| A4554 |
Disposable underpads, all sizes |
66 |
66 |
$2K |
| A4927 |
Gloves, non-sterile, per 100 |
106 |
104 |
$2K |
| A7526 |
Tracheostomy tube collar/holder, each |
15 |
15 |
$2K |
| A7000 |
Canister, disposable, used with suction pump, each |
52 |
52 |
$1K |
| A4217 |
Sterile water/saline, 500 ml |
33 |
33 |
$936.96 |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
41 |
41 |
$890.10 |
| A7002 |
Tubing, used with suction pump, each |
53 |
53 |
$508.32 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
34 |
34 |
$489.00 |
| A4657 |
Syringe, with or without needle, each |
78 |
77 |
$446.38 |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
28 |
28 |
$306.24 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
58 |
58 |
$206.01 |
| A7018 |
Water, distilled, used with large volume nebulizer, 1000 ml |
39 |
39 |
$139.23 |
| A4245 |
Alcohol wipes, per box |
26 |
26 |
$60.50 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
32 |
32 |
$20.78 |
| A7014 |
Filter, nondisposable, used with aerosol compressor or ultrasonic generator |
16 |
16 |
$0.00 |
| 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 |
12 |
12 |
$0.00 |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
13 |
13 |
$0.00 |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
12 |
12 |
$0.00 |
| A4335 |
Incontinence supply; miscellaneous |
80 |
80 |
$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 |
44 |
40 |
$0.00 |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
16 |
15 |
$0.00 |