| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
2,546 |
2,449 |
$1.48M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
5,285 |
5,193 |
$1.40M |
| B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
1,373 |
1,290 |
$1.30M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
5,670 |
5,588 |
$1.03M |
| A4554 |
Disposable underpads, all sizes |
13,741 |
13,610 |
$840K |
| B4149 |
Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
2,334 |
2,218 |
$796K |
| B9998 |
Noc for enteral supplies |
6,470 |
5,464 |
$700K |
| A4927 |
Gloves, non-sterile, per 100 |
23,385 |
22,996 |
$694K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
5,014 |
4,370 |
$661K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
4,526 |
4,449 |
$609K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
4,309 |
4,245 |
$556K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
4,434 |
4,356 |
$555K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
9,708 |
9,575 |
$507K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
3,126 |
3,087 |
$484K |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
671 |
631 |
$427K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
2,900 |
2,848 |
$347K |
| 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 |
2,714 |
2,590 |
$343K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
2,279 |
2,242 |
$306K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
2,171 |
2,145 |
$251K |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
786 |
760 |
$222K |
| 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 |
1,177 |
1,130 |
$211K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
10,991 |
10,788 |
$199K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
943 |
918 |
$125K |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
3,382 |
3,351 |
$124K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,021 |
1,010 |
$104K |
| B4104 |
Additive for enteral formula (e.g., fiber) |
935 |
735 |
$71K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
3,223 |
3,149 |
$67K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
1,301 |
1,284 |
$64K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
427 |
424 |
$58K |
| A4553 |
Non-disposable underpads, all sizes |
1,135 |
1,101 |
$38K |
| A4209 |
Syringe with needle, sterile 5 cc or greater, each |
3,323 |
3,272 |
$29K |
| A9901 |
Dme delivery, set up, and/or dispensing service component of another hcpcs code |
1,069 |
508 |
$16K |
| B4100 |
Food thickener, administered orally, per ounce |
144 |
89 |
$12K |
| A4452 |
Tape, waterproof, per 18 square inches |
947 |
934 |
$10K |
| T5999 |
Supply, not otherwise specified |
1,564 |
1,407 |
$8K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
104 |
100 |
$7K |
| A4332 |
Lubricant, individual sterile packet, each |
869 |
861 |
$7K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
59 |
52 |
$5K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
13 |
13 |
$1K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
13 |
12 |
$1K |
| B9002 |
Enteral nutrition infusion pump, any type |
64 |
62 |
$1K |
| A4245 |
Alcohol wipes, per box |
100 |
100 |
$1K |
| A4208 |
Syringe with needle, sterile 3 cc, each |
78 |
76 |
$337.14 |
| S8301 |
Infection control supplies, not otherwise specified |
24 |
24 |
$322.64 |
| A4244 |
Alcohol or peroxide, per pint |
404 |
400 |
$216.35 |