| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
26,901 |
17,891 |
$1.82M |
| A4554 |
Disposable underpads, all sizes |
65,890 |
44,719 |
$1.59M |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
7,732 |
7,522 |
$1.06M |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
18,930 |
12,819 |
$1.03M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
9,731 |
6,855 |
$909K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
10,006 |
6,928 |
$713K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
6,770 |
4,674 |
$597K |
| A4927 |
Gloves, non-sterile, per 100 |
22,751 |
17,710 |
$597K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
4,478 |
3,479 |
$537K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
7,144 |
4,813 |
$428K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
5,784 |
4,007 |
$265K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
2,334 |
1,692 |
$166K |
| L0621 |
Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf |
2,636 |
2,603 |
$161K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
193 |
133 |
$134K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
1,552 |
1,312 |
$68K |
| 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 |
593 |
520 |
$65K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,947 |
1,748 |
$60K |
| A4467 |
Belt, strap, sleeve, garment, or covering, any type |
1,730 |
1,035 |
$59K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,066 |
668 |
$53K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
804 |
498 |
$47K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
316 |
312 |
$41K |
| 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 |
490 |
408 |
$37K |
| A4930 |
Gloves, sterile, per pair |
278 |
277 |
$36K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
563 |
315 |
$23K |
| L2630 |
Addition to lower extremity, pelvic control, band and belt, unilateral |
107 |
98 |
$19K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
280 |
157 |
$17K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
130 |
117 |
$14K |
| A4335 |
Incontinence supply; miscellaneous |
1,849 |
1,514 |
$8K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
37 |
24 |
$8K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
121 |
103 |
$3K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
17 |
17 |
$3K |
| A6245 |
Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
82 |
76 |
$3K |
| T5999 |
Supply, not otherwise specified |
215 |
202 |
$801.36 |