| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
20,208 |
19,904 |
$766K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
5,794 |
5,739 |
$607K |
| 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 |
1,318 |
1,273 |
$582K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
10,529 |
10,370 |
$383K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
3,127 |
3,081 |
$380K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
4,284 |
4,232 |
$380K |
| E1399 |
Durable medical equipment, miscellaneous |
550 |
378 |
$321K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,558 |
1,483 |
$147K |
| A4335 |
Incontinence supply; miscellaneous |
22,296 |
21,892 |
$118K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
932 |
909 |
$69K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
907 |
812 |
$32K |
| E0570 |
Nebulizer, with compressor |
282 |
273 |
$24K |
| 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 |
154 |
151 |
$23K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
155 |
154 |
$13K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
62 |
60 |
$9K |
| A4927 |
Gloves, non-sterile, per 100 |
1,062 |
1,025 |
$8K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
77 |
76 |
$8K |
| A4259 |
Lancets, per box of 100 |
846 |
801 |
$5K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
48 |
48 |
$5K |
| A7006 |
Administration set, with small volume filtered pneumatic nebulizer |
200 |
197 |
$1K |
| A4245 |
Alcohol wipes, per box |
470 |
460 |
$902.32 |
| A7015 |
Aerosol mask, used with dme nebulizer |
202 |
197 |
$240.76 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
13 |
13 |
$217.29 |