| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6549 |
Gradient compression garment, not otherwise specified, for daytime use, each |
1,477 |
599 |
$549K |
| 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 |
1,805 |
1,561 |
$194K |
| A4554 |
Disposable underpads, all sizes |
3,815 |
3,441 |
$161K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,430 |
1,322 |
$144K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,393 |
1,281 |
$120K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
880 |
817 |
$88K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
709 |
682 |
$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 |
489 |
447 |
$57K |
| A4927 |
Gloves, non-sterile, per 100 |
2,388 |
2,180 |
$54K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
623 |
559 |
$24K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
19 |
18 |
$0.00 |