| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
11,827 |
10,513 |
$700K |
| 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 |
6,242 |
5,330 |
$615K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
4,048 |
3,707 |
$608K |
| S5165 |
Home modifications; per service |
140 |
108 |
$507K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,960 |
2,687 |
$408K |
| A4927 |
Gloves, non-sterile, per 100 |
14,672 |
12,741 |
$347K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
4,230 |
3,688 |
$323K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,970 |
1,815 |
$282K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,209 |
1,074 |
$203K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
6,080 |
5,191 |
$121K |
| 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 |
659 |
397 |
$116K |
| 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 |
429 |
352 |
$95K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
734 |
446 |
$81K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
289 |
255 |
$56K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
646 |
534 |
$23K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
113 |
39 |
$20K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
119 |
115 |
$14K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,219 |
886 |
$12K |
| 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 |
80 |
67 |
$12K |
| A4215 |
Needle, sterile, any size, each |
492 |
381 |
$10K |
| A4245 |
Alcohol wipes, per box |
1,241 |
951 |
$9K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
115 |
106 |
$8K |
| E1399 |
Durable medical equipment, miscellaneous |
99 |
28 |
$4K |
| S8490 |
Insulin syringes (100 syringes, any size) |
192 |
185 |
$4K |
| A4259 |
Lancets, per box of 100 |
997 |
727 |
$3K |
| A4670 |
Automatic blood pressure monitor |
41 |
39 |
$3K |
| E0325 |
Urinal; male, jug-type, any material |
476 |
360 |
$2K |
| E0245 |
Tub stool or bench |
12 |
12 |
$576.12 |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
12 |
12 |
$197.28 |