| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
19,359 |
17,842 |
$620K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
967 |
795 |
$92K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
10,979 |
10,170 |
$88K |
| A7031 |
Face mask interface, replacement for full face mask, each |
2,693 |
2,381 |
$54K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,730 |
1,592 |
$48K |
| E1392 |
Portable oxygen concentrator, rental |
2,142 |
2,053 |
$33K |
| 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 |
93 |
85 |
$31K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,378 |
1,295 |
$24K |
| 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 |
109 |
99 |
$13K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
1,757 |
1,616 |
$12K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
869 |
795 |
$11K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
4,607 |
4,190 |
$10K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
560 |
516 |
$8K |
| A7037 |
Tubing used with positive airway pressure device |
1,781 |
1,639 |
$8K |
| A7035 |
Headgear used with positive airway pressure device |
1,376 |
1,274 |
$8K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
476 |
452 |
$7K |
| E0570 |
Nebulizer, with compressor |
3,072 |
2,810 |
$6K |
| B9998 |
Noc for enteral supplies |
166 |
155 |
$5K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
1,006 |
935 |
$3K |
| 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 |
14 |
12 |
$870.57 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
1,306 |
1,145 |
$701.21 |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
13 |
12 |
$377.80 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
14 |
12 |
$0.93 |