| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
2,306 |
1,239 |
$209K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
2,742 |
1,498 |
$97K |
| A4456 |
Adhesive remover, wipes, any type, each |
3,716 |
2,150 |
$28K |
| 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 |
300 |
162 |
$22K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
744 |
449 |
$19K |
| A5120 |
Skin barrier, wipes or swabs, each |
3,740 |
2,196 |
$13K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
2,102 |
1,323 |
$12K |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
142 |
127 |
$9K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
50 |
38 |
$2K |
| A4371 |
Ostomy skin barrier, powder, per oz |
355 |
291 |
$976.44 |
| A4415 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 inches, each |
15 |
13 |
$827.74 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
22 |
12 |
$175.96 |