| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
1,416 |
1,414 |
$101K |
| 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 |
238 |
237 |
$101K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
768 |
765 |
$100K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
525 |
524 |
$94K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,433 |
1,430 |
$72K |
| A4927 |
Gloves, non-sterile, per 100 |
651 |
649 |
$10K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
24 |
24 |
$2K |