| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
2,144 |
2,029 |
$224K |
| A4554 |
Disposable underpads, all sizes |
4,976 |
4,751 |
$219K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,785 |
1,697 |
$178K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,640 |
1,570 |
$166K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,205 |
1,147 |
$108K |
| A4927 |
Gloves, non-sterile, per 100 |
4,240 |
4,059 |
$94K |
| 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 |
677 |
574 |
$85K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,455 |
1,306 |
$46K |
| A4335 |
Incontinence supply; miscellaneous |
5,210 |
4,946 |
$41K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,038 |
842 |
$16K |
| A4259 |
Lancets, per box of 100 |
104 |
86 |
$143.57 |