| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
3,519 |
2,981 |
$404K |
| A4554 |
Disposable underpads, all sizes |
10,713 |
9,355 |
$344K |
| 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 |
4,993 |
4,294 |
$324K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
4,087 |
3,564 |
$310K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
3,921 |
3,467 |
$300K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
6,823 |
6,029 |
$180K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
2,268 |
2,024 |
$177K |
| A4927 |
Gloves, non-sterile, per 100 |
5,488 |
4,712 |
$86K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
677 |
575 |
$73K |
| 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 |
651 |
571 |
$70K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
935 |
844 |
$65K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
397 |
386 |
$55K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
103 |
96 |
$13K |