| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
1,471 |
1,455 |
$540K |
| 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 |
2,554 |
2,487 |
$491K |
| T4541 |
Incontinence product, disposable underpad, large, each |
319 |
309 |
$13K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
205 |
189 |
$5K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
12 |
12 |
$693.00 |
| A4927 |
Gloves, non-sterile, per 100 |
45 |
45 |
$668.26 |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
68 |
67 |
$445.77 |
| A4335 |
Incontinence supply; miscellaneous |
54 |
54 |
$0.00 |