| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,800 |
2,697 |
$330K |
| A4554 |
Disposable underpads, all sizes |
6,754 |
6,553 |
$228K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,019 |
989 |
$126K |
| 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 |
422 |
408 |
$117K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,198 |
1,165 |
$103K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,883 |
2,791 |
$91K |
| A4335 |
Incontinence supply; miscellaneous |
7,489 |
7,250 |
$39K |
| 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 |
159 |
155 |
$18K |