| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2028 |
Specialized supply, not otherwise specified, waiver |
601 |
580 |
$78K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
138 |
99 |
$12K |
| A4335 |
Incontinence supply; miscellaneous |
525 |
407 |
$11K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
98 |
63 |
$7K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
49 |
29 |
$5K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
22 |
13 |
$4K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
22 |
16 |
$2K |
| A4927 |
Gloves, non-sterile, per 100 |
89 |
49 |
$2K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
18 |
16 |
$1K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
140 |
114 |
$1K |
| 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 |
197 |
153 |
$750.19 |