| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
5,579 |
3,379 |
$243K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
2,685 |
1,849 |
$177K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,966 |
2,030 |
$159K |
| T4541 |
Incontinence product, disposable underpad, large, each |
7,124 |
5,092 |
$158K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
773 |
619 |
$114K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,267 |
1,550 |
$111K |
| 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 |
1,803 |
1,246 |
$92K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,514 |
952 |
$88K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
4,009 |
2,799 |
$72K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
1,063 |
679 |
$64K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
1,029 |
690 |
$57K |
| 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 |
833 |
512 |
$56K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
937 |
667 |
$55K |
| A4927 |
Gloves, non-sterile, per 100 |
5,475 |
4,071 |
$54K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,023 |
642 |
$47K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
183 |
130 |
$30K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
985 |
650 |
$27K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
379 |
306 |
$10K |
| 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 |
232 |
136 |
$9K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
93 |
67 |
$3K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
55 |
24 |
$2K |
| A4670 |
Automatic blood pressure monitor |
40 |
28 |
$2K |
| T4536 |
Incontinence product, protective underwear/pull-on, reusable, any size, each |
22 |
14 |
$2K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
16 |
14 |
$62.10 |
| A4259 |
Lancets, per box of 100 |
14 |
12 |
$2.26 |
| G0008 |
Administration of influenza virus vaccine |
13 |
13 |
$0.00 |