| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
30,841 |
30,064 |
$2.54M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
14,053 |
13,695 |
$1.57M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
10,673 |
10,436 |
$1.56M |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
25,590 |
24,968 |
$890K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
4,970 |
4,855 |
$759K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
6,455 |
6,313 |
$579K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
4,750 |
4,629 |
$500K |
| 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 |
877 |
840 |
$158K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
6,239 |
6,093 |
$134K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
697 |
672 |
$118K |
| 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 |
484 |
460 |
$100K |
| A4927 |
Gloves, non-sterile, per 100 |
12,997 |
12,618 |
$59K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
709 |
678 |
$15K |
| A4322 |
Irrigation syringe, bulb or piston, each |
622 |
595 |
$8K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
55 |
53 |
$5K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
12 |
12 |
$2K |
| A4209 |
Syringe with needle, sterile 5 cc or greater, each |
78 |
74 |
$921.30 |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
14 |
13 |
$456.96 |
| A4452 |
Tape, waterproof, per 18 square inches |
48 |
48 |
$275.00 |