| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
3,216 |
2,442 |
$1.48M |
| T4541 |
Incontinence product, disposable underpad, large, each |
36,182 |
34,672 |
$1.27M |
| 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 |
7,813 |
6,710 |
$1.05M |
| 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 |
8,166 |
7,291 |
$936K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
10,298 |
9,637 |
$921K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
10,444 |
10,021 |
$891K |
| 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 |
5,068 |
4,297 |
$887K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,974 |
4,379 |
$836K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
8,515 |
7,823 |
$776K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
7,670 |
7,321 |
$767K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
9,874 |
9,429 |
$755K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
19,125 |
17,654 |
$660K |
| A4927 |
Gloves, non-sterile, per 100 |
46,038 |
42,912 |
$623K |
| 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 |
3,872 |
3,399 |
$560K |
| B4149 |
Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
1,070 |
845 |
$483K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
4,235 |
3,856 |
$415K |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
574 |
472 |
$403K |
| B4162 |
Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
655 |
514 |
$400K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
1,948 |
1,886 |
$376K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
3,785 |
3,608 |
$284K |
| B9998 |
Noc for enteral supplies |
5,169 |
4,158 |
$283K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
3,996 |
3,826 |
$279K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
2,899 |
2,762 |
$205K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,568 |
1,351 |
$151K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
2,401 |
2,216 |
$148K |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
863 |
688 |
$98K |
| B9002 |
Enteral nutrition infusion pump, any type |
771 |
722 |
$95K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
490 |
438 |
$93K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
760 |
694 |
$66K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
823 |
779 |
$52K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
605 |
570 |
$45K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
448 |
428 |
$45K |
| B4100 |
Food thickener, administered orally, per ounce |
604 |
493 |
$32K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
408 |
403 |
$22K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
125 |
110 |
$8K |
| B4158 |
Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
51 |
39 |
$7K |
| A4322 |
Irrigation syringe, bulb or piston, each |
543 |
481 |
$6K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
42 |
40 |
$5K |
| T4536 |
Incontinence product, protective underwear/pull-on, reusable, any size, each |
35 |
35 |
$4K |
| E0776 |
Iv pole |
61 |
55 |
$4K |
| B4082 |
Nasogastric tubing without stylet |
104 |
86 |
$1K |
| A5120 |
Skin barrier, wipes or swabs, each |
58 |
50 |
$405.60 |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
14 |
12 |
$260.93 |
| A4452 |
Tape, waterproof, per 18 square inches |
13 |
12 |
$216.32 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
13 |
12 |
$94.94 |