| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4100 |
Food thickener, administered orally, per ounce |
282 |
273 |
$46K |
| 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 |
376 |
362 |
$26K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
258 |
242 |
$17K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
197 |
187 |
$17K |
| T4541 |
Incontinence product, disposable underpad, large, each |
862 |
812 |
$12K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
125 |
123 |
$10K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
90 |
88 |
$8K |
| A4927 |
Gloves, non-sterile, per 100 |
820 |
771 |
$8K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
50 |
50 |
$5K |
| 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 |
12 |
12 |
$2K |
| K0001 |
Standard wheelchair |
26 |
26 |
$1K |