| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 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 |
1,003 |
963 |
$172K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,142 |
1,123 |
$61K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
224 |
211 |
$34K |
| A4927 |
Gloves, non-sterile, per 100 |
967 |
934 |
$23K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
66 |
64 |
$2K |
| G0008 |
Administration of influenza virus vaccine |
224 |
219 |
$0.00 |
| 90656 |
|
44 |
44 |
$0.00 |
| 90480 |
|
97 |
95 |
$0.00 |
| 90686 |
|
60 |
59 |
$0.00 |
| 90674 |
|
17 |
17 |
$0.00 |
| 0124A |
|
17 |
17 |
$0.00 |
| 91322 |
|
97 |
95 |
$0.00 |
| 90756 |
|
66 |
66 |
$0.00 |