| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,761 |
1,702 |
$201K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,114 |
1,978 |
$128K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,062 |
1,028 |
$92K |
| B4100 |
Food thickener, administered orally, per ounce |
879 |
783 |
$69K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
553 |
516 |
$61K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,274 |
1,809 |
$32K |
| 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 |
1,297 |
1,053 |
$27K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
123 |
122 |
$20K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
201 |
201 |
$19K |
| 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 |
1,562 |
1,315 |
$17K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
186 |
150 |
$6K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
135 |
134 |
$5K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
24 |
24 |
$3K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
1,477 |
1,423 |
$2K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
1,905 |
1,818 |
$2K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
432 |
356 |
$1K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
269 |
232 |
$854.05 |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
56 |
53 |
$757.81 |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
46 |
38 |
$747.02 |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
133 |
123 |
$678.74 |
| B9002 |
Enteral nutrition infusion pump, any type |
276 |
268 |
$325.72 |
| E0776 |
Iv pole |
827 |
795 |
$262.29 |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
24 |
24 |
$220.65 |
| A4629 |
Tracheostomy care kit for established tracheostomy |
41 |
39 |
$185.29 |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
44 |
44 |
$5.08 |