| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
498 |
489 |
$65K |
| 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 |
1,467 |
1,448 |
$47K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,124 |
1,106 |
$41K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
197 |
190 |
$30K |
| B4100 |
Food thickener, administered orally, per ounce |
381 |
357 |
$28K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
235 |
229 |
$24K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
294 |
292 |
$13K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,715 |
1,697 |
$12K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
926 |
918 |
$9K |
| A4554 |
Disposable underpads, all sizes |
152 |
152 |
$9K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
42 |
42 |
$229.83 |