| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
6,307 |
5,102 |
$699K |
| 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 |
1,969 |
1,607 |
$240K |
| A4927 |
Gloves, non-sterile, per 100 |
8,266 |
7,422 |
$115K |
| A4554 |
Disposable underpads, all sizes |
3,418 |
2,861 |
$105K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,017 |
767 |
$93K |
| 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 |
628 |
571 |
$85K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
592 |
505 |
$51K |
| 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 |
175 |
153 |
$35K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
166 |
164 |
$11K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
13 |
12 |
$1K |
| A5120 |
Skin barrier, wipes or swabs, each |
15 |
14 |
$14.26 |