| 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 |
14,523 |
14,049 |
$9.54M |
| 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 |
27,339 |
26,770 |
$6.38M |
| A4554 |
Disposable underpads, all sizes |
185,344 |
183,638 |
$6.05M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
41,501 |
40,983 |
$4.74M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
42,107 |
41,449 |
$3.88M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
15,160 |
13,911 |
$3.77M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
38,451 |
37,422 |
$3.53M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
22,630 |
22,342 |
$3.03M |
| A4335 |
Incontinence supply; miscellaneous |
241,206 |
238,908 |
$1.83M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
53,836 |
50,884 |
$1.71M |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
8,183 |
8,100 |
$1.55M |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
19,146 |
18,179 |
$1.47M |
| B9998 |
Noc for enteral supplies |
20,498 |
16,521 |
$1.38M |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
4,530 |
4,395 |
$1.29M |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
4,424 |
3,960 |
$1.29M |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
15,876 |
15,264 |
$1.14M |
| 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 |
5,341 |
5,139 |
$1.13M |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
677 |
585 |
$1.02M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
11,222 |
11,037 |
$962K |
| B4149 |
Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
2,380 |
2,266 |
$936K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
7,684 |
7,344 |
$850K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
8,157 |
8,011 |
$724K |
| 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 |
2,800 |
2,633 |
$719K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
6,466 |
6,420 |
$706K |
| B4158 |
Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
2,902 |
2,845 |
$648K |
| B9002 |
Enteral nutrition infusion pump, any type |
902 |
873 |
$586K |
| 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 |
881 |
800 |
$455K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,918 |
2,742 |
$349K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
2,854 |
2,731 |
$229K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
1,287 |
1,275 |
$178K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
2,413 |
2,366 |
$174K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
789 |
787 |
$140K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
1,267 |
1,211 |
$110K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
556 |
503 |
$85K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
10,537 |
10,353 |
$64K |
| A4322 |
Irrigation syringe, bulb or piston, each |
4,022 |
3,368 |
$63K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
1,150 |
1,106 |
$63K |
| B4100 |
Food thickener, administered orally, per ounce |
873 |
836 |
$62K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
87 |
75 |
$62K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
512 |
476 |
$60K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
1,635 |
1,609 |
$57K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,029 |
987 |
$53K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
599 |
582 |
$46K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
1,159 |
1,110 |
$44K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
2,218 |
1,518 |
$39K |
| A4927 |
Gloves, non-sterile, per 100 |
6,393 |
6,234 |
$39K |
| E0776 |
Iv pole |
441 |
434 |
$35K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
251 |
242 |
$34K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
2,289 |
2,236 |
$33K |
| A4456 |
Adhesive remover, wipes, any type, each |
3,861 |
3,739 |
$32K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
188 |
188 |
$32K |
| A5120 |
Skin barrier, wipes or swabs, each |
3,717 |
3,618 |
$31K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
2,665 |
2,567 |
$27K |
| A4371 |
Ostomy skin barrier, powder, per oz |
2,540 |
2,506 |
$22K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
1,201 |
1,128 |
$21K |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
351 |
344 |
$19K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,172 |
2,052 |
$18K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
299 |
286 |
$18K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
1,230 |
1,124 |
$18K |
| A4452 |
Tape, waterproof, per 18 square inches |
1,312 |
1,070 |
$14K |
| A4402 |
Lubricant, per ounce |
2,590 |
2,535 |
$12K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
1,073 |
1,008 |
$11K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
327 |
309 |
$11K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
1,208 |
1,177 |
$10K |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
183 |
181 |
$9K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
332 |
306 |
$9K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
120 |
116 |
$9K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
236 |
222 |
$8K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
187 |
179 |
$8K |
| A4259 |
Lancets, per box of 100 |
1,198 |
1,183 |
$6K |
| B4082 |
Nasogastric tubing without stylet |
145 |
136 |
$6K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,678 |
1,430 |
$5K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
262 |
254 |
$4K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
40 |
37 |
$3K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
500 |
488 |
$3K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
210 |
204 |
$3K |
| E2103 |
Non-adjunctive, non-implanted continuous glucose monitor or receiver |
12 |
12 |
$3K |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
241 |
235 |
$2K |
| K0554 |
Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system |
12 |
12 |
$2K |
| A4245 |
Alcohol wipes, per box |
631 |
628 |
$967.51 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
30 |
27 |
$867.73 |
| B4081 |
Nasogastric tubing with stylet |
12 |
12 |
$501.33 |
| A4367 |
Ostomy belt, each |
94 |
93 |
$493.90 |
| A4258 |
Spring-powered device for lancet, each |
73 |
73 |
$76.30 |
| S9999 |
Sales tax |
42 |
42 |
$0.00 |