| 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 |
13,589 |
11,473 |
$2.38M |
| 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 |
3,149 |
2,556 |
$838K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
12,082 |
11,342 |
$813K |
| A4554 |
Disposable underpads, all sizes |
22,910 |
21,740 |
$685K |
| B4100 |
Food thickener, administered orally, per ounce |
2,347 |
1,866 |
$630K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
6,726 |
6,467 |
$608K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
5,305 |
4,980 |
$534K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
8,129 |
7,698 |
$530K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
5,335 |
5,092 |
$456K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
4,948 |
4,700 |
$416K |
| A4927 |
Gloves, non-sterile, per 100 |
24,375 |
22,934 |
$282K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
2,306 |
2,216 |
$212K |
| A4259 |
Lancets, per box of 100 |
7,747 |
7,327 |
$120K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
1,258 |
1,225 |
$110K |
| E0570 |
Nebulizer, with compressor |
2,261 |
1,714 |
$90K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
871 |
815 |
$78K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
1,923 |
1,393 |
$72K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
941 |
868 |
$58K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
111 |
94 |
$36K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
1,453 |
1,036 |
$22K |
| E0246 |
Transfer tub rail attachment |
339 |
240 |
$21K |
| A4256 |
Normal, low and high calibrator solution / chips |
1,855 |
1,752 |
$11K |
| K0001 |
Standard wheelchair |
1,359 |
1,025 |
$10K |
| E0607 |
Home blood glucose monitor |
90 |
86 |
$3K |
| E0247 |
Transfer bench for tub or toilet with or without commode opening |
16 |
13 |
$1K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
19 |
12 |
$748.63 |
| E0156 |
Seat attachment, walker |
20 |
13 |
$186.21 |