| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
5,232 |
5,177 |
$2.73M |
| 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 |
9,607 |
9,406 |
$1.42M |
| A4927 |
Gloves, non-sterile, per 100 |
45,648 |
45,354 |
$1.39M |
| T4541 |
Incontinence product, disposable underpad, large, each |
27,314 |
27,187 |
$1.32M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
10,197 |
10,166 |
$1.22M |
| 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 |
5,929 |
5,865 |
$849K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
12,569 |
12,497 |
$775K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
4,677 |
4,638 |
$705K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
7,441 |
7,386 |
$698K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
5,030 |
5,013 |
$668K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
4,315 |
4,300 |
$650K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
5,989 |
5,970 |
$646K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
6,164 |
6,142 |
$612K |
| B4100 |
Food thickener, administered orally, per ounce |
5,852 |
5,785 |
$566K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
1,922 |
1,912 |
$513K |
| 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 |
2,668 |
2,649 |
$399K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
24,923 |
24,810 |
$395K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
2,222 |
2,206 |
$271K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,013 |
952 |
$174K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
713 |
644 |
$148K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
607 |
591 |
$65K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
367 |
360 |
$56K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
729 |
713 |
$28K |
| A9901 |
Dme delivery, set up, and/or dispensing service component of another hcpcs code |
6,424 |
6,423 |
$19K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
43 |
38 |
$18K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
1,495 |
1,445 |
$14K |
| 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 |
95 |
91 |
$11K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
2,410 |
2,371 |
$9K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
478 |
434 |
$4K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
1,168 |
1,144 |
$4K |
| A4217 |
Sterile water/saline, 500 ml |
227 |
219 |
$3K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
280 |
276 |
$2K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
98 |
91 |
$771.39 |
| A4402 |
Lubricant, per ounce |
61 |
61 |
$156.52 |
| A5120 |
Skin barrier, wipes or swabs, each |
14 |
13 |
$107.12 |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
56 |
52 |
$77.10 |