| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
3,518 |
3,427 |
$160K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,872 |
1,796 |
$128K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,319 |
1,276 |
$102K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,450 |
1,421 |
$83K |
| 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 |
781 |
769 |
$79K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,161 |
2,099 |
$68K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
182 |
168 |
$38K |
| A4927 |
Gloves, non-sterile, per 100 |
611 |
605 |
$9K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
140 |
136 |
$4K |
| K0003 |
Lightweight wheelchair |
91 |
88 |
$2K |