| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
4,100 |
3,987 |
$753K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
9,245 |
8,678 |
$753K |
| A4554 |
Disposable underpads, all sizes |
8,123 |
7,926 |
$466K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
4,935 |
4,827 |
$269K |
| A4927 |
Gloves, non-sterile, per 100 |
9,386 |
8,888 |
$221K |
| E0221 |
Infrared heating pad system |
100 |
58 |
$219K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,646 |
1,590 |
$197K |
| 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 |
497 |
470 |
$139K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
578 |
570 |
$106K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
359 |
348 |
$55K |
| 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 |
525 |
500 |
$52K |
| E1399 |
Durable medical equipment, miscellaneous |
257 |
240 |
$42K |
| 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 |
96 |
92 |
$19K |
| E0570 |
Nebulizer, with compressor |
338 |
335 |
$16K |
| A4252 |
Blood ketone test or reagent strip, each |
24 |
24 |
$11K |
| E0135 |
Walker, folding (pickup), adjustable or fixed height |
243 |
226 |
$10K |
| A4627 |
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
309 |
308 |
$8K |
| E0245 |
Tub stool or bench |
143 |
137 |
$7K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
13 |
12 |
$2K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
239 |
226 |
$2K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
34 |
34 |
$1K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
29 |
29 |
$1K |
| A4259 |
Lancets, per box of 100 |
254 |
241 |
$919.79 |
| A4245 |
Alcohol wipes, per box |
131 |
128 |
$610.00 |