| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,212 |
1,141 |
$269K |
| 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 |
708 |
678 |
$172K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
4,121 |
3,908 |
$160K |
| A4554 |
Disposable underpads, all sizes |
2,459 |
2,311 |
$135K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
2,888 |
2,706 |
$105K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
268 |
249 |
$102K |
| A4927 |
Gloves, non-sterile, per 100 |
2,617 |
2,496 |
$75K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,448 |
1,385 |
$74K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
133 |
111 |
$33K |
| 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 |
164 |
161 |
$20K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
109 |
93 |
$17K |
| L3206 |
Orthopedic shoe, hightop with supinator or pronator, child |
54 |
52 |
$13K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
65 |
51 |
$9K |
| A4930 |
Gloves, sterile, per pair |
27 |
25 |
$3K |
| E0570 |
Nebulizer, with compressor |
201 |
190 |
$2K |
| A4670 |
Automatic blood pressure monitor |
28 |
27 |
$2K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
46 |
46 |
$2K |
| A4245 |
Alcohol wipes, per box |
77 |
75 |
$364.00 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
14 |
14 |
$255.34 |
| A4617 |
Mouth piece |
15 |
15 |
$44.25 |
| A7015 |
Aerosol mask, used with dme nebulizer |
14 |
14 |
$19.18 |