| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A9274 |
External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories |
7,733 |
7,156 |
$4.01M |
| 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 |
1,157 |
990 |
$396K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
2,268 |
2,164 |
$343K |
| 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 |
1,167 |
1,089 |
$242K |
| A4927 |
Gloves, non-sterile, per 100 |
7,067 |
5,969 |
$239K |
| A4554 |
Disposable underpads, all sizes |
5,828 |
5,502 |
$230K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,268 |
1,196 |
$190K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,479 |
1,394 |
$188K |
| 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 |
443 |
413 |
$73K |
| A4335 |
Incontinence supply; miscellaneous |
6,914 |
6,491 |
$55K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
284 |
266 |
$40K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
25 |
24 |
$6K |