| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,046 |
987 |
$113K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
857 |
801 |
$86K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
533 |
492 |
$66K |
| 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 |
590 |
520 |
$38K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
394 |
355 |
$13K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
1,215 |
1,123 |
$13K |
| A4772 |
Blood glucose test strips, for dialysis, per 50 |
167 |
80 |
$6K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
29 |
27 |
$4K |
| T4541 |
Incontinence product, disposable underpad, large, each |
166 |
155 |
$3K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
39 |
37 |
$2K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
12 |
12 |
$2K |
| A4258 |
Spring-powered device for lancet, each |
202 |
103 |
$786.84 |
| A4245 |
Alcohol wipes, per box |
48 |
28 |
$232.65 |