| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
20,292 |
19,584 |
$2.24M |
| 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 |
11,834 |
11,128 |
$1.71M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
5,798 |
5,081 |
$1.66M |
| 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 |
1,886 |
1,670 |
$1.17M |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
10,641 |
10,004 |
$862K |
| B4149 |
Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
1,451 |
1,267 |
$665K |
| B9002 |
Enteral nutrition infusion pump, any type |
9,786 |
6,022 |
$644K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
6,194 |
5,948 |
$643K |
| 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 |
3,786 |
3,426 |
$544K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
6,287 |
5,825 |
$495K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
4,846 |
4,536 |
$396K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
2,403 |
2,247 |
$381K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
3,385 |
3,264 |
$361K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,182 |
1,917 |
$319K |
| 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 |
1,245 |
1,087 |
$231K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,883 |
1,670 |
$205K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
1,205 |
943 |
$177K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,829 |
1,669 |
$146K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
1,073 |
982 |
$108K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
680 |
622 |
$87K |
| 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 |
987 |
880 |
$68K |
| A4554 |
Disposable underpads, all sizes |
2,800 |
2,433 |
$66K |
| A4927 |
Gloves, non-sterile, per 100 |
3,385 |
3,057 |
$65K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
408 |
384 |
$40K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
92 |
73 |
$17K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
646 |
558 |
$12K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
145 |
124 |
$12K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
85 |
76 |
$10K |
| A4657 |
Syringe, with or without needle, each |
4,420 |
3,901 |
$10K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,308 |
1,148 |
$6K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
38 |
38 |
$3K |
| A4452 |
Tape, waterproof, per 18 square inches |
336 |
293 |
$1K |
| A5120 |
Skin barrier, wipes or swabs, each |
138 |
132 |
$961.50 |