| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
432 |
407 |
$69K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
133 |
123 |
$33K |
| 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 |
112 |
87 |
$27K |
| A4927 |
Gloves, non-sterile, per 100 |
422 |
404 |
$16K |
| T4541 |
Incontinence product, disposable underpad, large, each |
164 |
156 |
$14K |