| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
6,741 |
6,680 |
$712K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
3,879 |
3,720 |
$523K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
18,006 |
17,790 |
$457K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
4,036 |
3,910 |
$445K |
| T4541 |
Incontinence product, disposable underpad, large, each |
11,002 |
10,919 |
$367K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
3,719 |
3,688 |
$355K |
| A4927 |
Gloves, non-sterile, per 100 |
12,178 |
11,658 |
$314K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
10,517 |
10,353 |
$277K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,895 |
1,750 |
$248K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,285 |
2,275 |
$232K |
| 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 |
1,352 |
1,236 |
$208K |
| 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 |
1,923 |
1,758 |
$196K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,809 |
1,789 |
$188K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
1,550 |
1,535 |
$131K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
909 |
902 |
$99K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
659 |
657 |
$56K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
281 |
278 |
$26K |
| 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 |
74 |
74 |
$20K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,963 |
1,802 |
$16K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
52 |
50 |
$13K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
84 |
84 |
$8K |
| A4215 |
Needle, sterile, any size, each |
68 |
63 |
$2K |
| B4100 |
Food thickener, administered orally, per ounce |
21 |
14 |
$514.80 |
| A4259 |
Lancets, per box of 100 |
292 |
272 |
$243.42 |