| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
50,891 |
48,650 |
$1.68M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
11,109 |
10,776 |
$1.53M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
10,974 |
10,337 |
$1.23M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
9,732 |
9,282 |
$1.08M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
5,644 |
5,444 |
$922K |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
408 |
398 |
$800K |
| 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 |
2,273 |
2,189 |
$655K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
15,980 |
15,331 |
$574K |
| 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 |
1,555 |
1,428 |
$529K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,616 |
1,544 |
$450K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
4,659 |
4,445 |
$437K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
4,093 |
3,944 |
$403K |
| B9998 |
Noc for enteral supplies |
4,132 |
3,021 |
$359K |
| 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 |
1,289 |
1,195 |
$347K |
| A4335 |
Incontinence supply; miscellaneous |
62,262 |
58,515 |
$319K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,781 |
1,728 |
$270K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
2,154 |
2,015 |
$260K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,383 |
1,253 |
$248K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
9,710 |
7,869 |
$248K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
1,123 |
1,021 |
$221K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,719 |
1,614 |
$150K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
1,382 |
1,325 |
$113K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,314 |
1,278 |
$86K |
| E0570 |
Nebulizer, with compressor |
1,228 |
1,178 |
$73K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
400 |
385 |
$60K |
| 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 |
184 |
147 |
$56K |
| A4259 |
Lancets, per box of 100 |
7,318 |
6,512 |
$50K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
448 |
439 |
$46K |
| 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 |
48 |
48 |
$43K |
| A4670 |
Automatic blood pressure monitor |
756 |
733 |
$39K |
| A7000 |
Canister, disposable, used with suction pump, each |
755 |
735 |
$38K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
462 |
438 |
$32K |
| A7002 |
Tubing, used with suction pump, each |
761 |
729 |
$12K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
1,353 |
1,168 |
$12K |
| A4322 |
Irrigation syringe, bulb or piston, each |
1,051 |
998 |
$9K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
2,506 |
2,418 |
$8K |
| B4100 |
Food thickener, administered orally, per ounce |
139 |
136 |
$6K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,408 |
1,285 |
$6K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
465 |
454 |
$6K |
| A4402 |
Lubricant, per ounce |
941 |
741 |
$4K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
1,653 |
1,163 |
$4K |
| A4245 |
Alcohol wipes, per box |
2,408 |
2,195 |
$4K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
664 |
642 |
$4K |
| A5120 |
Skin barrier, wipes or swabs, each |
503 |
442 |
$4K |
| A4456 |
Adhesive remover, wipes, any type, each |
420 |
387 |
$3K |
| A4371 |
Ostomy skin barrier, powder, per oz |
119 |
119 |
$1K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
24 |
12 |
$894.48 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
76 |
76 |
$733.58 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
97 |
91 |
$433.22 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
41 |
37 |
$210.27 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
38 |
28 |
$0.00 |