| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,571 |
1,436 |
$296K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,031 |
990 |
$196K |
| 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 |
443 |
404 |
$179K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
4,335 |
4,153 |
$164K |
| T4541 |
Incontinence product, disposable underpad, large, each |
6,197 |
5,817 |
$128K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
479 |
463 |
$86K |
| K0003 |
Lightweight wheelchair |
970 |
936 |
$31K |
| A4927 |
Gloves, non-sterile, per 100 |
1,726 |
1,704 |
$28K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
101 |
79 |
$23K |
| E0570 |
Nebulizer, with compressor |
605 |
542 |
$18K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
92 |
85 |
$4K |
| A7006 |
Administration set, with small volume filtered pneumatic nebulizer |
78 |
77 |
$662.22 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
110 |
109 |
$645.56 |
| A4660 |
Sphygmomanometer/blood pressure apparatus with cuff and stethoscope |
13 |
12 |
$272.68 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
150 |
142 |
$153.87 |