| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A5120 |
Skin barrier, wipes or swabs, each |
77,443 |
30,960 |
$6.01M |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
34,685 |
32,761 |
$4.08M |
| 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 |
28,708 |
21,090 |
$3.52M |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
24,082 |
22,528 |
$2.69M |
| 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 |
11,503 |
8,242 |
$1.30M |
| B4100 |
Food thickener, administered orally, per ounce |
8,502 |
5,105 |
$634K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
5,629 |
5,211 |
$588K |
| 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 |
3,353 |
2,080 |
$427K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
4,526 |
4,199 |
$359K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
3,382 |
3,163 |
$349K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,928 |
2,739 |
$322K |
| A4927 |
Gloves, non-sterile, per 100 |
10,754 |
9,990 |
$268K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,507 |
1,391 |
$151K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,031 |
978 |
$112K |
| A4554 |
Disposable underpads, all sizes |
797 |
756 |
$50K |
| 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 |
132 |
90 |
$29K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
176 |
173 |
$18K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
102 |
99 |
$10K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
14 |
12 |
$1K |