| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
16,464 |
16,398 |
$627K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
4,499 |
4,437 |
$519K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
10,785 |
10,495 |
$457K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,925 |
2,892 |
$298K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
2,022 |
1,989 |
$277K |
| A4335 |
Incontinence supply; miscellaneous |
19,072 |
18,823 |
$109K |
| 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 |
763 |
617 |
$87K |
| 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 |
316 |
285 |
$86K |
| E1399 |
Durable medical equipment, miscellaneous |
90 |
79 |
$61K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,767 |
1,705 |
$31K |
| A4259 |
Lancets, per box of 100 |
1,241 |
1,219 |
$5K |
| A4245 |
Alcohol wipes, per box |
212 |
212 |
$415.84 |