| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
135,160 |
129,457 |
$6.80M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
33,663 |
32,164 |
$3.90M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
37,236 |
35,579 |
$3.84M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
26,422 |
25,098 |
$3.01M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
23,720 |
22,699 |
$2.77M |
| 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 |
4,580 |
4,197 |
$2.13M |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
18,511 |
17,643 |
$2.04M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
8,543 |
7,582 |
$1.97M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
15,203 |
14,458 |
$1.85M |
| A4928 |
Surgical mask, per 20 |
11,435 |
10,916 |
$1.79M |
| 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 |
3,226 |
2,932 |
$1.69M |
| A4927 |
Gloves, non-sterile, per 100 |
53,806 |
50,724 |
$1.65M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
13,702 |
12,965 |
$1.64M |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
8,676 |
8,332 |
$1.46M |
| 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 |
8,272 |
7,804 |
$1.22M |
| 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 |
9,843 |
8,394 |
$1.11M |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
8,740 |
8,320 |
$976K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
8,963 |
8,379 |
$924K |
| 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 |
1,458 |
1,281 |
$897K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
6,415 |
6,097 |
$747K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
5,334 |
4,510 |
$608K |
| 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 |
4,227 |
3,253 |
$605K |
| 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 |
2,861 |
2,572 |
$603K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
4,749 |
4,453 |
$569K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
5,173 |
4,427 |
$487K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
4,882 |
4,693 |
$442K |
| B9998 |
Noc for enteral supplies |
26,457 |
11,433 |
$356K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
9,191 |
8,564 |
$349K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
2,083 |
1,593 |
$259K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
1,470 |
1,393 |
$221K |
| 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 |
1,509 |
1,380 |
$211K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
1,232 |
1,185 |
$113K |
| B9002 |
Enteral nutrition infusion pump, any type |
69 |
60 |
$59K |
| B4100 |
Food thickener, administered orally, per ounce |
737 |
614 |
$41K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
1,821 |
1,644 |
$33K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
499 |
331 |
$23K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
1,321 |
866 |
$12K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
148 |
108 |
$10K |
| E1399 |
Durable medical equipment, miscellaneous |
117 |
111 |
$9K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
71 |
62 |
$9K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
618 |
458 |
$8K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
33 |
24 |
$5K |
| A4402 |
Lubricant, per ounce |
1,125 |
903 |
$4K |
| A5120 |
Skin barrier, wipes or swabs, each |
506 |
325 |
$2K |
| A4456 |
Adhesive remover, wipes, any type, each |
167 |
129 |
$1K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
61 |
38 |
$1K |
| A4217 |
Sterile water/saline, 500 ml |
42 |
24 |
$900.07 |
| A4371 |
Ostomy skin barrier, powder, per oz |
113 |
81 |
$746.05 |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
32 |
24 |
$536.60 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
38 |
25 |
$364.08 |
| A4657 |
Syringe, with or without needle, each |
18 |
15 |
$0.00 |