| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
5,387 |
5,052 |
$294K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,248 |
1,212 |
$153K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,018 |
982 |
$102K |
| A4927 |
Gloves, non-sterile, per 100 |
2,926 |
2,752 |
$90K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
631 |
622 |
$80K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
283 |
280 |
$39K |
| 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 |
332 |
276 |
$18K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
39 |
38 |
$7K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
45 |
41 |
$5K |
| 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 |
106 |
82 |
$2K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
28 |
26 |
$442.00 |