| 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 |
5,642 |
5,064 |
$785K |
| 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 |
1,357 |
1,234 |
$464K |
| 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 |
3,596 |
3,210 |
$407K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
2,539 |
2,393 |
$177K |
| 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 |
2,083 |
1,890 |
$177K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,976 |
1,829 |
$129K |
| 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 |
588 |
555 |
$113K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,624 |
1,588 |
$112K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,669 |
1,621 |
$77K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
522 |
518 |
$73K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
463 |
451 |
$66K |
| E0601 |
Continuous positive airway pressure (cpap) device |
1,021 |
957 |
$49K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
158 |
154 |
$28K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
766 |
697 |
$17K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
141 |
138 |
$15K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
454 |
439 |
$15K |
| B9002 |
Enteral nutrition infusion pump, any type |
431 |
410 |
$15K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
103 |
96 |
$13K |
| E1392 |
Portable oxygen concentrator, rental |
603 |
563 |
$11K |
| E0776 |
Iv pole |
1,581 |
1,448 |
$7K |
| K0001 |
Standard wheelchair |
201 |
201 |
$4K |
| E0570 |
Nebulizer, with compressor |
177 |
174 |
$3K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
276 |
268 |
$3K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
647 |
601 |
$2K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
37 |
37 |
$820.17 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
138 |
127 |
$707.15 |
| A7015 |
Aerosol mask, used with dme nebulizer |
390 |
376 |
$645.31 |
| A7013 |
Filter, disposable, used with aerosol compressor or ultrasonic generator |
466 |
437 |
$392.48 |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
138 |
136 |
$20.04 |
| A4256 |
Normal, low and high calibrator solution / chips |
46 |
46 |
$0.00 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
46 |
46 |
$0.00 |
| A4259 |
Lancets, per box of 100 |
46 |
46 |
$0.00 |