| 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 |
15,339 |
8,447 |
$2.04M |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
3,867 |
3,470 |
$643K |
| 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 |
6,050 |
3,379 |
$581K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
1,985 |
1,840 |
$525K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
6,195 |
3,706 |
$521K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
7,090 |
4,221 |
$520K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
4,187 |
3,755 |
$456K |
| 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 |
1,688 |
959 |
$291K |
| B9002 |
Enteral nutrition infusion pump, any type |
2,778 |
2,408 |
$231K |
| E0424 |
Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing |
1,365 |
1,273 |
$214K |
| 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 |
2,583 |
1,648 |
$176K |
| E0601 |
Continuous positive airway pressure (cpap) device |
2,235 |
2,032 |
$162K |
| 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 |
521 |
347 |
$161K |
| 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 |
1,683 |
1,012 |
$140K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
3,181 |
2,992 |
$88K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
1,141 |
1,070 |
$71K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
1,046 |
747 |
$60K |
| 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 |
1,905 |
1,761 |
$49K |
| E0619 |
Apnea monitor, with recording feature |
170 |
164 |
$43K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
1,544 |
1,485 |
$39K |
| A4222 |
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
471 |
158 |
$35K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
1,091 |
1,017 |
$35K |
| A7030 |
Full face mask used with positive airway pressure device, each |
268 |
251 |
$31K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
138 |
129 |
$31K |
| B9998 |
Noc for enteral supplies |
1,229 |
902 |
$30K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
169 |
101 |
$28K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
126 |
113 |
$21K |
| A7035 |
Headgear used with positive airway pressure device |
623 |
577 |
$16K |
| B4082 |
Nasogastric tubing without stylet |
1,009 |
874 |
$16K |
| E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
594 |
553 |
$15K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
673 |
359 |
$14K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
178 |
172 |
$11K |
| E0776 |
Iv pole |
84 |
76 |
$7K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
1,087 |
1,007 |
$7K |
| A7526 |
Tracheostomy tube collar/holder, each |
160 |
141 |
$7K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
98 |
81 |
$5K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
328 |
298 |
$4K |
| A7000 |
Canister, disposable, used with suction pump, each |
523 |
468 |
$4K |
| E1226 |
Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each |
58 |
56 |
$3K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
328 |
286 |
$3K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
113 |
102 |
$2K |
| A7002 |
Tubing, used with suction pump, each |
521 |
465 |
$2K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
556 |
517 |
$2K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
33 |
26 |
$2K |
| E0570 |
Nebulizer, with compressor |
13 |
12 |
$1K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
1,321 |
1,215 |
$1K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
57 |
54 |
$984.68 |
| A7031 |
Face mask interface, replacement for full face mask, each |
32 |
26 |
$925.37 |
| A4565 |
Slings |
145 |
138 |
$813.19 |
| A4629 |
Tracheostomy care kit for established tracheostomy |
15 |
12 |
$616.33 |
| K0001 |
Standard wheelchair |
13 |
13 |
$580.85 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
40 |
38 |
$556.82 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
115 |
66 |
$414.43 |
| A4556 |
Electrodes, (e.g., apnea monitor), per pair |
13 |
12 |
$292.03 |
| A7037 |
Tubing used with positive airway pressure device |
67 |
58 |
$230.02 |
| E1399 |
Durable medical equipment, miscellaneous |
18 |
12 |
$37.47 |