| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
26,713 |
26,669 |
$1.90M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
27,525 |
27,453 |
$1.54M |
| A4554 |
Disposable underpads, all sizes |
52,031 |
51,911 |
$1.39M |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
14,525 |
14,482 |
$1.11M |
| E1399 |
Durable medical equipment, miscellaneous |
4,401 |
4,307 |
$793K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
4,406 |
4,391 |
$648K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
20,221 |
20,176 |
$526K |
| 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 |
3,149 |
3,145 |
$291K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
6,128 |
6,114 |
$233K |
| 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 |
1,385 |
1,385 |
$197K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
3,218 |
3,215 |
$164K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
1,783 |
1,650 |
$143K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
2,301 |
2,299 |
$84K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
2,312 |
2,305 |
$61K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
1,825 |
1,815 |
$48K |
| A4402 |
Lubricant, per ounce |
6,008 |
5,997 |
$41K |
| K0001 |
Standard wheelchair |
1,597 |
1,595 |
$39K |
| A4335 |
Incontinence supply; miscellaneous |
319 |
318 |
$36K |
| A4670 |
Automatic blood pressure monitor |
627 |
627 |
$35K |
| E0241 |
Bath tub wall rail, each |
785 |
782 |
$29K |
| 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 |
264 |
264 |
$28K |
| A4259 |
Lancets, per box of 100 |
1,989 |
1,983 |
$17K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
160 |
160 |
$14K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
394 |
392 |
$12K |
| E0244 |
Raised toilet seat |
365 |
365 |
$7K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
70 |
70 |
$6K |
| B9998 |
Noc for enteral supplies |
19 |
19 |
$4K |
| E0156 |
Seat attachment, walker |
169 |
169 |
$4K |
| A4245 |
Alcohol wipes, per box |
1,609 |
1,604 |
$4K |
| A4649 |
Surgical supply; miscellaneous |
101 |
101 |
$2K |
| B4100 |
Food thickener, administered orally, per ounce |
25 |
25 |
$543.87 |
| A4927 |
Gloves, non-sterile, per 100 |
99 |
99 |
$494.31 |