| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
5,431 |
5,136 |
$360K |
| 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 |
3,231 |
3,015 |
$218K |
| 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 |
1,441 |
1,347 |
$170K |
| A4927 |
Gloves, non-sterile, per 100 |
6,917 |
6,552 |
$169K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,523 |
1,469 |
$132K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,411 |
1,367 |
$131K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,748 |
2,596 |
$126K |
| A4335 |
Incontinence supply; miscellaneous |
3,743 |
3,594 |
$58K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
757 |
729 |
$53K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
176 |
159 |
$21K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
37 |
36 |
$4K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
12 |
12 |
$2K |