| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
6,834 |
2,603 |
$187K |
| A4554 |
Disposable underpads, all sizes |
5,199 |
5,012 |
$162K |
| X1939 |
|
2,524 |
2,434 |
$147K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,147 |
1,100 |
$122K |
| T5999 |
Supply, not otherwise specified |
11,352 |
10,432 |
$106K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
2,304 |
1,046 |
$103K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
703 |
670 |
$85K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,597 |
1,523 |
$78K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,753 |
1,126 |
$76K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,186 |
1,163 |
$74K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,377 |
1,335 |
$68K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,962 |
1,883 |
$55K |
| X1915 |
|
459 |
431 |
$37K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
557 |
494 |
$36K |
| X1922 |
|
283 |
239 |
$36K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
410 |
358 |
$30K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
474 |
412 |
$28K |
| 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 |
1,234 |
568 |
$25K |
| A4927 |
Gloves, non-sterile, per 100 |
1,617 |
1,081 |
$23K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,262 |
595 |
$20K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
335 |
314 |
$19K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,039 |
435 |
$18K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
178 |
167 |
$14K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
3,482 |
1,412 |
$8K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
1,304 |
471 |
$6K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
1,504 |
570 |
$5K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
2,168 |
826 |
$4K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
440 |
237 |
$3K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
2,311 |
895 |
$2K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
229 |
151 |
$2K |
| E0776 |
Iv pole |
480 |
270 |
$1K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
171 |
80 |
$858.31 |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
133 |
95 |
$799.93 |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
41 |
24 |
$267.81 |