| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
9,683 |
9,454 |
$442K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
4,623 |
4,543 |
$395K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
4,094 |
4,037 |
$322K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
2,121 |
2,076 |
$182K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
512 |
482 |
$166K |
| T4541 |
Incontinence product, disposable underpad, large, each |
4,529 |
4,451 |
$163K |
| A5120 |
Skin barrier, wipes or swabs, each |
6,485 |
6,152 |
$74K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
1,916 |
1,905 |
$53K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
671 |
659 |
$44K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
299 |
294 |
$28K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
213 |
209 |
$19K |
| A4927 |
Gloves, non-sterile, per 100 |
6,074 |
5,954 |
$17K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
187 |
180 |
$11K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
48 |
45 |
$11K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
1,384 |
1,378 |
$4K |
| 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 |
54 |
54 |
$1K |
| 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 |
84 |
80 |
$1K |
| 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 |
45 |
39 |
$866.32 |
| A4335 |
Incontinence supply; miscellaneous |
1,336 |
1,331 |
$583.99 |
| A4405 |
Ostomy skin barrier, non-pectin based, paste, per ounce |
424 |
424 |
$293.94 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
17 |
16 |
$36.70 |