| 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 |
1,108 |
996 |
$33K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
423 |
412 |
$10K |
| 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 |
125 |
98 |
$7K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
165 |
127 |
$7K |
| 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 |
581 |
543 |
$2K |
| A7030 |
Full face mask used with positive airway pressure device, each |
12 |
12 |
$809.70 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
44 |
42 |
$656.60 |
| A7037 |
Tubing used with positive airway pressure device |
45 |
45 |
$640.87 |
| K0001 |
Standard wheelchair |
26 |
26 |
$565.45 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
113 |
78 |
$289.04 |