| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
1,893 |
1,786 |
$1.35M |
| A4554 |
Disposable underpads, all sizes |
30,995 |
29,234 |
$876K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
9,751 |
9,267 |
$833K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
9,702 |
9,251 |
$789K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
9,653 |
8,108 |
$722K |
| 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 |
4,449 |
4,309 |
$710K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
5,348 |
5,182 |
$690K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
6,173 |
5,872 |
$675K |
| E1399 |
Durable medical equipment, miscellaneous |
6,030 |
5,281 |
$674K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
642 |
615 |
$570K |
| A4927 |
Gloves, non-sterile, per 100 |
32,199 |
30,264 |
$518K |
| A4245 |
Alcohol wipes, per box |
34,260 |
31,943 |
$500K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
3,166 |
3,090 |
$410K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
1,039 |
995 |
$308K |
| 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 |
2,119 |
2,028 |
$290K |
| 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 |
1,277 |
1,235 |
$247K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
5,117 |
4,835 |
$219K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
2,116 |
2,046 |
$219K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
1,702 |
1,621 |
$207K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
2,429 |
2,310 |
$201K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
2,493 |
2,333 |
$191K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
2,070 |
1,970 |
$188K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
2,086 |
2,057 |
$171K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,366 |
1,326 |
$140K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
1,583 |
1,533 |
$133K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,035 |
1,006 |
$121K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,374 |
1,312 |
$108K |
| A4371 |
Ostomy skin barrier, powder, per oz |
1,697 |
1,585 |
$104K |
| A4452 |
Tape, waterproof, per 18 square inches |
2,494 |
2,417 |
$87K |
| B9998 |
Noc for enteral supplies |
791 |
741 |
$80K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
735 |
714 |
$73K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
2,061 |
1,929 |
$70K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,188 |
1,164 |
$60K |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
130 |
128 |
$56K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
1,083 |
1,035 |
$53K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,473 |
2,429 |
$51K |
| A6210 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
128 |
125 |
$39K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
378 |
367 |
$36K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
197 |
194 |
$35K |
| S5199 |
Personal care item, nos, each |
640 |
558 |
$34K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
162 |
157 |
$31K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
1,464 |
1,430 |
$30K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
145 |
142 |
$30K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
326 |
322 |
$29K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
289 |
273 |
$29K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
1,108 |
1,080 |
$29K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
272 |
268 |
$22K |
| A4456 |
Adhesive remover, wipes, any type, each |
2,765 |
2,671 |
$18K |
| 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 |
123 |
120 |
$17K |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
192 |
189 |
$15K |
| A5120 |
Skin barrier, wipes or swabs, each |
3,104 |
2,927 |
$15K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
1,842 |
1,783 |
$13K |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
209 |
202 |
$7K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
288 |
274 |
$7K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
118 |
115 |
$7K |
| E0570 |
Nebulizer, with compressor |
89 |
87 |
$7K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
576 |
561 |
$4K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
58 |
58 |
$3K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
636 |
619 |
$3K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
25 |
24 |
$3K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
12 |
12 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
150 |
145 |
$156.11 |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
50 |
48 |
$88.54 |
| A7015 |
Aerosol mask, used with dme nebulizer |
69 |
69 |
$3.37 |