| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
947 |
919 |
$97K |
| A4554 |
Disposable underpads, all sizes |
1,424 |
1,408 |
$47K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
327 |
316 |
$34K |
| A4927 |
Gloves, non-sterile, per 100 |
1,417 |
1,402 |
$26K |
| K0001 |
Standard wheelchair |
637 |
567 |
$7K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
51 |
51 |
$4K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
110 |
85 |
$1K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
39 |
37 |
$102.50 |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
15 |
13 |
$8.40 |