| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
3,918 |
3,776 |
$663K |
| A4554 |
Disposable underpads, all sizes |
6,079 |
5,878 |
$208K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
544 |
524 |
$128K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,422 |
2,334 |
$84K |
| 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 |
281 |
265 |
$55K |
| 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 |
81 |
79 |
$48K |
| E1399 |
Durable medical equipment, miscellaneous |
53 |
51 |
$36K |
| A4335 |
Incontinence supply; miscellaneous |
6,973 |
6,722 |
$35K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
119 |
115 |
$16K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
284 |
201 |
$6K |
| A4670 |
Automatic blood pressure monitor |
114 |
112 |
$6K |
| A4927 |
Gloves, non-sterile, per 100 |
845 |
800 |
$6K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
44 |
42 |
$3K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
401 |
387 |
$2K |
| A4259 |
Lancets, per box of 100 |
212 |
201 |
$1K |
| A4245 |
Alcohol wipes, per box |
210 |
201 |
$315.08 |