| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
26,126 |
25,965 |
$958K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
15,566 |
14,550 |
$437K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
3,903 |
3,884 |
$386K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
7,093 |
7,060 |
$324K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
7,804 |
7,763 |
$278K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
3,967 |
3,939 |
$257K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
863 |
830 |
$230K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
20,444 |
20,315 |
$216K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
4,599 |
4,570 |
$214K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,381 |
1,361 |
$211K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
3,150 |
3,125 |
$177K |
| A4335 |
Incontinence supply; miscellaneous |
20,403 |
20,277 |
$172K |
| B9998 |
Noc for enteral supplies |
2,127 |
2,025 |
$164K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
2,761 |
2,732 |
$160K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
1,929 |
1,912 |
$110K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
881 |
835 |
$106K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
551 |
541 |
$103K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
792 |
787 |
$87K |
| S9999 |
Sales tax |
8,700 |
8,580 |
$85K |
| A4322 |
Irrigation syringe, bulb or piston, each |
1,936 |
1,836 |
$81K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
510 |
501 |
$59K |
| A4927 |
Gloves, non-sterile, per 100 |
3,986 |
3,935 |
$54K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,627 |
1,620 |
$53K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
2,068 |
2,067 |
$33K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
288 |
288 |
$15K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
809 |
801 |
$14K |
| A4456 |
Adhesive remover, wipes, any type, each |
1,009 |
1,003 |
$13K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
461 |
457 |
$11K |
| A5120 |
Skin barrier, wipes or swabs, each |
1,136 |
1,132 |
$10K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
388 |
385 |
$8K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
754 |
728 |
$8K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
105 |
101 |
$6K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
41 |
40 |
$6K |
| A4371 |
Ostomy skin barrier, powder, per oz |
541 |
535 |
$5K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
108 |
104 |
$2K |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
93 |
92 |
$1K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
49 |
49 |
$1K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
75 |
75 |
$983.15 |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
36 |
36 |
$897.83 |
| A4402 |
Lubricant, per ounce |
52 |
51 |
$233.64 |
| 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 |
605 |
584 |
$0.00 |
| 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 |
12 |
12 |
$0.00 |