| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
568 |
392 |
$1.15M |
| A4554 |
Disposable underpads, all sizes |
888 |
810 |
$56K |
| 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 |
206 |
170 |
$30K |
| A5120 |
Skin barrier, wipes or swabs, each |
1,674 |
1,077 |
$22K |
| A4927 |
Gloves, non-sterile, per 100 |
1,287 |
1,019 |
$21K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
1,277 |
1,017 |
$8K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
12 |
12 |
$4K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
13 |
13 |
$1K |