| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
12,050 |
11,385 |
$522K |
| A4927 |
Gloves, non-sterile, per 100 |
11,084 |
10,482 |
$291K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
3,168 |
2,970 |
$286K |
| 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 |
3,574 |
2,975 |
$280K |
| 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 |
2,061 |
1,680 |
$260K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
2,586 |
2,438 |
$258K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,963 |
1,812 |
$174K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
3,485 |
2,875 |
$101K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
416 |
403 |
$65K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
417 |
398 |
$45K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
327 |
315 |
$29K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
129 |
126 |
$14K |
| A4335 |
Incontinence supply; miscellaneous |
1,320 |
1,241 |
$10K |
| A4928 |
Surgical mask, per 20 |
483 |
455 |
$8K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
80 |
76 |
$7K |
| 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 |
20 |
12 |
$2K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
12 |
12 |
$1K |