| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
9,313 |
8,966 |
$813K |
| T4541 |
Incontinence product, disposable underpad, large, each |
12,878 |
12,750 |
$650K |
| B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
3,492 |
3,359 |
$602K |
| 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 |
3,890 |
3,791 |
$584K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,284 |
3,213 |
$359K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,798 |
1,793 |
$297K |
| B9998 |
Noc for enteral supplies |
4,583 |
4,412 |
$293K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,219 |
1,214 |
$226K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,984 |
1,948 |
$208K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,909 |
1,902 |
$206K |
| A4322 |
Irrigation syringe, bulb or piston, each |
2,912 |
2,863 |
$205K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
4,916 |
4,780 |
$203K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
2,124 |
2,108 |
$191K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
1,889 |
1,875 |
$173K |
| A4670 |
Automatic blood pressure monitor |
1,921 |
1,910 |
$168K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,037 |
2,004 |
$134K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
823 |
821 |
$114K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,644 |
1,637 |
$110K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,083 |
2,055 |
$107K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,478 |
1,470 |
$100K |
| 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 |
1,222 |
1,196 |
$93K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
5,009 |
4,949 |
$62K |
| A4335 |
Incontinence supply; miscellaneous |
5,016 |
4,949 |
$49K |
| 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 |
556 |
548 |
$41K |
| E0570 |
Nebulizer, with compressor |
782 |
643 |
$37K |
| E1399 |
Durable medical equipment, miscellaneous |
4,693 |
4,485 |
$35K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,311 |
2,259 |
$33K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
719 |
715 |
$31K |
| A4927 |
Gloves, non-sterile, per 100 |
1,464 |
1,436 |
$20K |
| A7000 |
Canister, disposable, used with suction pump, each |
357 |
326 |
$20K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
402 |
400 |
$19K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
264 |
263 |
$19K |
| B9002 |
Enteral nutrition infusion pump, any type |
15 |
15 |
$10K |
| 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 |
27 |
27 |
$5K |
| K0001 |
Standard wheelchair |
206 |
191 |
$5K |
| A4657 |
Syringe, with or without needle, each |
346 |
309 |
$3K |
| A7002 |
Tubing, used with suction pump, each |
38 |
38 |
$1K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
60 |
59 |
$1K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
13 |
13 |
$908.85 |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
37 |
37 |
$666.99 |
| A7015 |
Aerosol mask, used with dme nebulizer |
46 |
45 |
$46.11 |