| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
2,938 |
2,865 |
$192K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
2,065 |
2,026 |
$183K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
958 |
938 |
$106K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
252 |
245 |
$37K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
279 |
272 |
$30K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
432 |
419 |
$12K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
98 |
96 |
$8K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
37 |
37 |
$6K |
| 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 |
28 |
24 |
$6K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
12 |
12 |
$2K |
| A4927 |
Gloves, non-sterile, per 100 |
310 |
287 |
$1K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
14 |
13 |
$222.30 |
| 0124A |
|
13 |
13 |
$0.00 |