| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
11,200 |
11,061 |
$478K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
4,133 |
4,086 |
$296K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
2,712 |
2,669 |
$274K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
3,312 |
3,265 |
$221K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
4,316 |
4,258 |
$85K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
3,018 |
2,983 |
$79K |
| 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 |
410 |
409 |
$56K |
| 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 |
613 |
610 |
$54K |
| 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 |
272 |
266 |
$46K |
| A4927 |
Gloves, non-sterile, per 100 |
7,951 |
7,859 |
$37K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
447 |
437 |
$35K |
| 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 |
212 |
212 |
$21K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
223 |
215 |
$15K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
131 |
130 |
$14K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
205 |
201 |
$5K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
77 |
77 |
$3K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
55 |
54 |
$2K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
12 |
12 |
$815.36 |