| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
6,768 |
6,185 |
$1.25M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
4,169 |
3,877 |
$768K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
4,010 |
3,792 |
$745K |
| A4927 |
Gloves, non-sterile, per 100 |
16,872 |
15,492 |
$690K |
| 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 |
4,557 |
4,230 |
$643K |
| A4335 |
Incontinence supply; miscellaneous |
21,524 |
19,850 |
$618K |
| 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 |
3,199 |
2,927 |
$612K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
3,031 |
2,865 |
$606K |
| B4100 |
Food thickener, administered orally, per ounce |
3,145 |
2,645 |
$593K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
3,147 |
2,952 |
$566K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
2,478 |
2,279 |
$490K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
4,403 |
4,172 |
$454K |
| T4541 |
Incontinence product, disposable underpad, large, each |
6,715 |
6,530 |
$361K |
| 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 |
2,393 |
2,235 |
$216K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
6,590 |
6,441 |
$196K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
5,338 |
5,215 |
$138K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
1,087 |
1,035 |
$69K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
80 |
74 |
$21K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
125 |
117 |
$15K |
| 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 |
71 |
66 |
$15K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
310 |
309 |
$5K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
12 |
12 |
$2K |