| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4927 |
Gloves, non-sterile, per 100 |
1,554 |
1,508 |
$26K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
185 |
184 |
$19K |
| T4541 |
Incontinence product, disposable underpad, large, each |
467 |
458 |
$18K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
143 |
138 |
$16K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
141 |
134 |
$15K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
122 |
114 |
$11K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
122 |
120 |
$11K |
| 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 |
54 |
53 |
$10K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
237 |
227 |
$10K |
| 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 |
57 |
53 |
$9K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
65 |
61 |
$7K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
29 |
29 |
$7K |
| B9998 |
Noc for enteral supplies |
70 |
68 |
$6K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
28 |
26 |
$5K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
25 |
25 |
$3K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
39 |
38 |
$2K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
87 |
86 |
$1K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
12 |
12 |
$89.60 |