| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
6,700 |
5,661 |
$1.08M |
| 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 |
2,428 |
1,904 |
$434K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,463 |
1,260 |
$240K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,025 |
924 |
$182K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
1,200 |
1,032 |
$116K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
598 |
529 |
$104K |
| B9998 |
Noc for enteral supplies |
1,278 |
1,049 |
$66K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
307 |
268 |
$34K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
242 |
203 |
$30K |
| A4927 |
Gloves, non-sterile, per 100 |
1,016 |
981 |
$10K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
217 |
206 |
$3K |