| 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 |
5,147 |
5,127 |
$315K |
| E0601 |
Continuous positive airway pressure (cpap) device |
3,058 |
3,046 |
$138K |
| A7030 |
Full face mask used with positive airway pressure device, each |
1,055 |
1,047 |
$64K |
| A7031 |
Face mask interface, replacement for full face mask, each |
1,694 |
1,681 |
$56K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,841 |
2,823 |
$41K |
| 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 |
85 |
38 |
$38K |
| 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 |
104 |
50 |
$36K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
2,936 |
2,927 |
$32K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
2,553 |
2,531 |
$17K |
| A7035 |
Headgear used with positive airway pressure device |
1,025 |
1,017 |
$14K |
| A4604 |
Tubing with integrated heating element for use with positive airway pressure device |
651 |
648 |
$13K |
| 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 |
368 |
366 |
$12K |
| A7037 |
Tubing used with positive airway pressure device |
600 |
596 |
$9K |
| E0570 |
Nebulizer, with compressor |
362 |
362 |
$9K |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
945 |
943 |
$7K |
| A7034 |
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap |
174 |
174 |
$6K |
| E1392 |
Portable oxygen concentrator, rental |
276 |
276 |
$3K |
| A7033 |
Pillow for use on nasal cannula type interface, replacement only, pair |
37 |
37 |
$1K |
| A7032 |
Cushion for use on nasal mask interface, replacement only, each |
25 |
25 |
$774.64 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
41 |
40 |
$65.11 |