| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
1,517 |
1,464 |
$156K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
510 |
510 |
$68K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
317 |
316 |
$58K |
| A4335 |
Incontinence supply; miscellaneous |
685 |
659 |
$54K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
265 |
254 |
$31K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
788 |
742 |
$31K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
208 |
198 |
$27K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
185 |
179 |
$26K |
| 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 |
160 |
160 |
$23K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
71 |
63 |
$14K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
330 |
316 |
$10K |
| 99605 |
|
45 |
45 |
$2K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
29 |
28 |
$1K |
| 99607 |
|
61 |
57 |
$830.00 |
| S5199 |
Personal care item, nos, each |
36 |
36 |
$627.50 |
| E0240 |
Bath/shower chair, with or without wheels, any size |
12 |
12 |
$429.38 |
| A4452 |
Tape, waterproof, per 18 square inches |
47 |
40 |
$413.27 |
| A4927 |
Gloves, non-sterile, per 100 |
33 |
27 |
$317.76 |
| T4541 |
Incontinence product, disposable underpad, large, each |
12 |
12 |
$285.00 |