| 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 |
3,213 |
2,785 |
$1.72M |
| B9998 |
Noc for enteral supplies |
6,660 |
3,196 |
$1.01M |
| 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 |
1,538 |
1,057 |
$667K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
3,218 |
2,989 |
$605K |
| 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 |
1,124 |
824 |
$275K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,695 |
1,435 |
$268K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
1,350 |
812 |
$199K |
| 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 |
570 |
402 |
$177K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,680 |
1,548 |
$141K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
4,100 |
1,140 |
$98K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
857 |
787 |
$96K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
2,027 |
1,915 |
$37K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
168 |
117 |
$24K |
| A4657 |
Syringe, with or without needle, each |
2,475 |
1,765 |
$21K |
| A4927 |
Gloves, non-sterile, per 100 |
311 |
233 |
$18K |
| E0465 |
Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) |
16 |
12 |
$14K |
| A4217 |
Sterile water/saline, 500 ml |
105 |
76 |
$7K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
12 |
12 |
$421.94 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
13 |
12 |
$262.80 |
| A4452 |
Tape, waterproof, per 18 square inches |
13 |
13 |
$77.20 |