| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,306 |
1,221 |
$108K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
3,150 |
2,887 |
$93K |
| 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 |
875 |
693 |
$31K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
227 |
163 |
$10K |
| T4541 |
Incontinence product, disposable underpad, large, each |
320 |
259 |
$7K |
| S5165 |
Home modifications; per service |
18 |
18 |
$2K |
| A5120 |
Skin barrier, wipes or swabs, each |
45 |
42 |
$350.32 |
| 90686 |
|
150 |
150 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
702 |
702 |
$0.00 |
| 90688 |
|
165 |
165 |
$0.00 |
| 90694 |
|
99 |
99 |
$0.00 |
| 90662 |
|
147 |
147 |
$0.00 |
| 90756 |
|
25 |
25 |
$0.00 |
| 90653 |
|
21 |
21 |
$0.00 |
| A9901 |
Dme delivery, set up, and/or dispensing service component of another hcpcs code |
58 |
58 |
$0.00 |