| Code | Description | Claims | Beneficiaries | 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 |
2,195 |
1,933 |
$410K |
| 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 |
1,082 |
1,001 |
$179K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
978 |
863 |
$160K |
| A4554 |
Disposable underpads, all sizes |
1,388 |
1,230 |
$79K |
| A4927 |
Gloves, non-sterile, per 100 |
1,414 |
1,246 |
$37K |
| A4335 |
Incontinence supply; miscellaneous |
1,402 |
1,241 |
$22K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
42 |
40 |
$6K |
| A4452 |
Tape, waterproof, per 18 square inches |
147 |
131 |
$3K |