| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
265 |
255 |
$254K |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
140 |
129 |
$174K |
| 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 |
369 |
329 |
$158K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
1,150 |
1,054 |
$108K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
223 |
222 |
$41K |
| K0001 |
Standard wheelchair |
2,475 |
1,973 |
$38K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
1,028 |
945 |
$19K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
198 |
182 |
$17K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
149 |
144 |
$11K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
206 |
133 |
$6K |
| E0570 |
Nebulizer, with compressor |
115 |
103 |
$5K |
| A4927 |
Gloves, non-sterile, per 100 |
366 |
354 |
$5K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
484 |
425 |
$5K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
65 |
65 |
$5K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
155 |
148 |
$4K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
86 |
38 |
$4K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
51 |
51 |
$3K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
55 |
49 |
$3K |
| B9002 |
Enteral nutrition infusion pump, any type |
50 |
49 |
$3K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
86 |
84 |
$2K |
| A4554 |
Disposable underpads, all sizes |
40 |
39 |
$1K |
| E0601 |
Continuous positive airway pressure (cpap) device |
26 |
25 |
$1K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
115 |
102 |
$1K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
27 |
26 |
$1K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
64 |
57 |
$955.91 |
| B4082 |
Nasogastric tubing without stylet |
12 |
12 |
$743.12 |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
77 |
77 |
$622.84 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
72 |
69 |
$468.72 |
| A5120 |
Skin barrier, wipes or swabs, each |
82 |
72 |
$392.72 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
122 |
107 |
$132.38 |