| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
17 |
17 |
$0.00 |
| A7038 |
Filter, disposable, used with positive airway pressure device |
13 |
13 |
$0.00 |
| A7035 |
Headgear used with positive airway pressure device |
13 |
13 |
$0.00 |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
12 |
12 |
$0.00 |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
34 |
34 |
$0.00 |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
20 |
20 |
$0.00 |
| T4541 |
Incontinence product, disposable underpad, large, each |
71 |
71 |
$0.00 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
12 |
12 |
$0.00 |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
16 |
16 |
$0.00 |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
22 |
22 |
$0.00 |
| T4542 |
Incontinence product, disposable underpad, small size, each |
14 |
14 |
$0.00 |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
23 |
23 |
$0.00 |
| A4335 |
Incontinence supply; miscellaneous |
21 |
21 |
$0.00 |
| 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 |
39 |
23 |
$0.00 |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
26 |
26 |
$0.00 |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
29 |
29 |
$0.00 |