| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
5,745 |
5,614 |
$523K |
| A4554 |
Disposable underpads, all sizes |
6,677 |
6,466 |
$406K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,087 |
1,018 |
$261K |
| A4927 |
Gloves, non-sterile, per 100 |
7,223 |
7,073 |
$189K |
| 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 |
868 |
845 |
$181K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,015 |
1,994 |
$153K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
7,029 |
6,887 |
$135K |
| 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 |
1,276 |
1,261 |
$119K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
2,248 |
2,182 |
$84K |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
26 |
24 |
$4K |