| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
58,704 |
57,640 |
$1.82M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
19,194 |
18,628 |
$1.61M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
39,414 |
36,321 |
$1.32M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
10,026 |
9,053 |
$1.29M |
| B9998 |
Noc for enteral supplies |
13,632 |
11,862 |
$1.03M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
15,430 |
14,944 |
$963K |
| 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 |
11,033 |
8,493 |
$941K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
11,999 |
10,719 |
$938K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
6,652 |
6,431 |
$887K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
10,764 |
10,515 |
$807K |
| 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 |
3,554 |
3,206 |
$755K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
12,667 |
12,411 |
$654K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
15,969 |
15,540 |
$642K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
7,855 |
7,583 |
$468K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
7,806 |
7,591 |
$452K |
| T5999 |
Supply, not otherwise specified |
3,808 |
3,230 |
$449K |
| A4322 |
Irrigation syringe, bulb or piston, each |
23,459 |
13,428 |
$317K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
4,431 |
4,197 |
$237K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
3,728 |
3,586 |
$232K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,964 |
2,915 |
$179K |
| S9433 |
Medical food nutritionally complete, administered orally, providing 100% of nutritional intake |
436 |
365 |
$168K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,002 |
1,888 |
$141K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
3,548 |
3,368 |
$117K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
3,559 |
3,513 |
$103K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
253 |
235 |
$80K |
| A4927 |
Gloves, non-sterile, per 100 |
5,879 |
5,576 |
$70K |
| 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 |
883 |
697 |
$68K |
| S9999 |
Sales tax |
10,160 |
7,265 |
$63K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
552 |
537 |
$62K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
816 |
790 |
$58K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
7,065 |
7,010 |
$53K |
| A4335 |
Incontinence supply; miscellaneous |
8,504 |
8,414 |
$53K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
8,358 |
7,857 |
$50K |
| A7526 |
Tracheostomy tube collar/holder, each |
542 |
502 |
$43K |
| 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 |
316 |
239 |
$43K |
| 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 |
175 |
142 |
$20K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
160 |
136 |
$15K |
| A7000 |
Canister, disposable, used with suction pump, each |
477 |
474 |
$10K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
138 |
125 |
$9K |
| A4623 |
Tracheostomy, inner cannula |
53 |
48 |
$7K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
40 |
38 |
$5K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
381 |
325 |
$5K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
51 |
49 |
$5K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
445 |
371 |
$4K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
75 |
75 |
$3K |
| A4657 |
Syringe, with or without needle, each |
773 |
593 |
$3K |
| A7002 |
Tubing, used with suction pump, each |
174 |
167 |
$966.88 |
| E0776 |
Iv pole |
12 |
12 |
$834.04 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
32 |
25 |
$709.71 |
| T4536 |
Incontinence product, protective underwear/pull-on, reusable, any size, each |
38 |
38 |
$390.32 |
| A4456 |
Adhesive remover, wipes, any type, each |
51 |
51 |
$356.03 |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
24 |
24 |
$89.57 |
| A5120 |
Skin barrier, wipes or swabs, each |
25 |
24 |
$49.00 |