| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,145 |
854 |
$79K |
| A4554 |
Disposable underpads, all sizes |
2,068 |
1,533 |
$67K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
821 |
662 |
$59K |
| 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 |
872 |
749 |
$52K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,332 |
1,168 |
$47K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
719 |
556 |
$46K |
| 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 |
230 |
195 |
$15K |