| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
391,324 |
384,782 |
$35.55M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
786,999 |
772,481 |
$34.05M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
266,958 |
262,478 |
$28.37M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
285,845 |
280,350 |
$23.06M |
| T4541 |
Incontinence product, disposable underpad, large, each |
620,781 |
608,480 |
$22.29M |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
76,388 |
74,673 |
$12.87M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
76,051 |
72,976 |
$6.91M |
| A4927 |
Gloves, non-sterile, per 100 |
531,808 |
496,630 |
$6.56M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
58,085 |
55,294 |
$5.82M |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
68,922 |
67,134 |
$5.15M |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
39,589 |
38,481 |
$5.06M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
45,344 |
43,651 |
$4.92M |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
112,398 |
110,757 |
$4.21M |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
16,405 |
15,792 |
$3.24M |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
26,262 |
25,517 |
$3.13M |
| A4554 |
Disposable underpads, all sizes |
116,425 |
108,362 |
$2.29M |
| 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 |
27,431 |
26,032 |
$2.24M |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
43,372 |
37,252 |
$1.97M |
| S5170 |
Home delivered meals, including preparation; per meal |
37,690 |
25,244 |
$1.81M |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
16,513 |
16,008 |
$1.70M |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
64,434 |
63,618 |
$1.35M |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
12,774 |
9,652 |
$1.16M |
| E1399 |
Durable medical equipment, miscellaneous |
9,578 |
8,826 |
$907K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
31,579 |
28,555 |
$750K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
5,995 |
5,779 |
$722K |
| 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 |
6,860 |
6,684 |
$677K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
1,310 |
1,045 |
$629K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
5,783 |
5,598 |
$499K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
9,714 |
9,386 |
$413K |
| 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 |
2,903 |
2,119 |
$358K |
| 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 |
2,073 |
1,889 |
$242K |
| A4335 |
Incontinence supply; miscellaneous |
12,488 |
11,674 |
$196K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
890 |
854 |
$75K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
1,611 |
1,341 |
$61K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
3,022 |
2,444 |
$60K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
7,722 |
5,796 |
$49K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
1,153 |
899 |
$32K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
6,082 |
4,530 |
$29K |
| B4100 |
Food thickener, administered orally, per ounce |
547 |
500 |
$24K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
1,321 |
1,037 |
$18K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
614 |
502 |
$17K |
| A4402 |
Lubricant, per ounce |
4,822 |
4,190 |
$16K |
| A4452 |
Tape, waterproof, per 18 square inches |
1,433 |
1,136 |
$15K |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
54 |
50 |
$14K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
863 |
847 |
$14K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,359 |
1,085 |
$11K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
2,120 |
1,480 |
$10K |
| A5120 |
Skin barrier, wipes or swabs, each |
2,128 |
1,750 |
$9K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
170 |
121 |
$8K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
355 |
241 |
$7K |
| A4322 |
Irrigation syringe, bulb or piston, each |
779 |
662 |
$6K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
814 |
699 |
$5K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
787 |
666 |
$5K |
| A4456 |
Adhesive remover, wipes, any type, each |
963 |
789 |
$4K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
1,443 |
1,046 |
$4K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
116 |
103 |
$4K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
85 |
73 |
$4K |
| A4332 |
Lubricant, individual sterile packet, each |
1,281 |
670 |
$3K |
| A4553 |
Non-disposable underpads, all sizes |
4,740 |
2,453 |
$3K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
317 |
281 |
$3K |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
980 |
745 |
$1K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
331 |
292 |
$905.55 |
| A4670 |
Automatic blood pressure monitor |
15 |
13 |
$823.89 |
| A4371 |
Ostomy skin barrier, powder, per oz |
219 |
194 |
$555.76 |
| A4388 |
Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each |
13 |
12 |
$299.60 |
| A4245 |
Alcohol wipes, per box |
58 |
49 |
$200.61 |
| A4367 |
Ostomy belt, each |
31 |
24 |
$80.67 |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
16 |
12 |
$80.47 |
| A4217 |
Sterile water/saline, 500 ml |
18 |
12 |
$56.44 |