| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
13,794 |
13,575 |
$2.14M |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
4,393 |
4,249 |
$1.58M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
11,290 |
11,068 |
$1.57M |
| A4927 |
Gloves, non-sterile, per 100 |
71,816 |
67,522 |
$1.41M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
10,142 |
9,921 |
$1.21M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
7,221 |
6,981 |
$923K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
6,269 |
6,030 |
$908K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
5,548 |
5,431 |
$871K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
5,281 |
5,104 |
$838K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
21,337 |
21,071 |
$813K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,192 |
2,814 |
$742K |
| T4541 |
Incontinence product, disposable underpad, large, each |
29,252 |
28,565 |
$648K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
12,362 |
12,118 |
$459K |
| 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 |
1,317 |
1,277 |
$423K |
| 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 |
1,661 |
1,596 |
$304K |
| 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 |
1,646 |
1,524 |
$296K |
| B4100 |
Food thickener, administered orally, per ounce |
5,798 |
5,635 |
$261K |
| B9998 |
Noc for enteral supplies |
1,864 |
1,588 |
$244K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,575 |
1,527 |
$134K |
| 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 |
204 |
190 |
$129K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
894 |
863 |
$128K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
637 |
618 |
$106K |
| A4322 |
Irrigation syringe, bulb or piston, each |
3,211 |
2,921 |
$106K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,625 |
1,553 |
$92K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
738 |
710 |
$61K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
363 |
359 |
$55K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
732 |
693 |
$30K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
243 |
203 |
$28K |
| 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 |
99 |
94 |
$26K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
924 |
840 |
$25K |
| A4554 |
Disposable underpads, all sizes |
1,129 |
1,099 |
$21K |
| A4553 |
Non-disposable underpads, all sizes |
462 |
446 |
$14K |
| A6210 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
28 |
27 |
$7K |
| A4259 |
Lancets, per box of 100 |
631 |
580 |
$7K |
| 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 |
67 |
61 |
$5K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
79 |
66 |
$4K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
26 |
25 |
$3K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
380 |
331 |
$2K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
422 |
392 |
$2K |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
150 |
119 |
$1K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
576 |
547 |
$1K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
58 |
50 |
$283.54 |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
45 |
38 |
$67.11 |