| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
2,342 |
2,018 |
$115K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,436 |
1,817 |
$106K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,510 |
1,790 |
$100K |
| 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 |
822 |
765 |
$70K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
466 |
458 |
$37K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
217 |
213 |
$12K |
| A5120 |
Skin barrier, wipes or swabs, each |
630 |
556 |
$7K |
| T4541 |
Incontinence product, disposable underpad, large, each |
84 |
80 |
$3K |
| 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 |
26 |
$2K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
12 |
12 |
$728.64 |
| A4554 |
Disposable underpads, all sizes |
81 |
41 |
$0.00 |