| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
9,590 |
5,576 |
$263K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,969 |
1,639 |
$194K |
| A4554 |
Disposable underpads, all sizes |
3,487 |
3,315 |
$159K |
| 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 |
510 |
400 |
$72K |
| 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 |
265 |
225 |
$55K |
| A4927 |
Gloves, non-sterile, per 100 |
1,602 |
1,382 |
$33K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
63 |
60 |
$8K |
| B9998 |
Noc for enteral supplies |
436 |
358 |
$6K |
| A4670 |
Automatic blood pressure monitor |
90 |
86 |
$6K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
48 |
48 |
$5K |
| E0570 |
Nebulizer, with compressor |
54 |
47 |
$5K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
38 |
37 |
$4K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
25 |
24 |
$3K |
| A4335 |
Incontinence supply; miscellaneous |
77 |
69 |
$549.45 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
106 |
96 |
$16.64 |