| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
3,464 |
3,185 |
$1.39M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
5,598 |
5,358 |
$786K |
| E1399 |
Durable medical equipment, miscellaneous |
4,068 |
3,492 |
$786K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
3,561 |
3,423 |
$642K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
5,509 |
5,268 |
$639K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
4,579 |
4,031 |
$561K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
3,132 |
2,938 |
$486K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
3,965 |
2,843 |
$457K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
2,732 |
2,636 |
$432K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
4,000 |
2,809 |
$391K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
6,615 |
6,265 |
$149K |
| A4649 |
Surgical supply; miscellaneous |
13,448 |
12,740 |
$138K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
953 |
918 |
$137K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
938 |
457 |
$123K |
| B4100 |
Food thickener, administered orally, per ounce |
461 |
449 |
$103K |
| A4927 |
Gloves, non-sterile, per 100 |
19,738 |
18,458 |
$93K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
806 |
749 |
$87K |
| A4554 |
Disposable underpads, all sizes |
12,931 |
12,122 |
$83K |
| 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 |
97 |
86 |
$18K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
316 |
102 |
$9K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
15 |
12 |
$3K |
| 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 |
29 |
27 |
$2K |
| A4670 |
Automatic blood pressure monitor |
72 |
44 |
$1K |