| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
610 |
581 |
$95K |
| A4554 |
Disposable underpads, all sizes |
1,828 |
1,696 |
$88K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
403 |
373 |
$54K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,839 |
890 |
$43K |
| 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 |
1,937 |
920 |
$31K |
| A4927 |
Gloves, non-sterile, per 100 |
2,378 |
2,214 |
$25K |
| K0001 |
Standard wheelchair |
1,454 |
1,101 |
$18K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,107 |
550 |
$13K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
81 |
75 |
$13K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
682 |
532 |
$4K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
79 |
63 |
$2K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
756 |
584 |
$1K |
| B9002 |
Enteral nutrition infusion pump, any type |
65 |
40 |
$569.70 |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
30 |
15 |
$187.90 |
| E0776 |
Iv pole |
40 |
24 |
$39.14 |