| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
63,682 |
62,087 |
$3.87M |
| A4554 |
Disposable underpads, all sizes |
136,790 |
131,291 |
$3.31M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
59,996 |
58,610 |
$3.31M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
33,305 |
32,517 |
$2.34M |
| A4245 |
Alcohol wipes, per box |
139,134 |
133,985 |
$1.32M |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
12,364 |
12,088 |
$1.27M |
| A4927 |
Gloves, non-sterile, per 100 |
156,049 |
150,198 |
$1.19M |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
10,044 |
9,810 |
$1.14M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
24,862 |
24,243 |
$1.08M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
14,514 |
14,133 |
$833K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
11,506 |
11,225 |
$824K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
8,838 |
8,591 |
$489K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
8,689 |
8,509 |
$478K |
| S5199 |
Personal care item, nos, each |
29,303 |
27,576 |
$416K |
| 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 |
2,864 |
2,714 |
$365K |
| A5120 |
Skin barrier, wipes or swabs, each |
49,734 |
47,433 |
$303K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
460 |
429 |
$250K |
| 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 |
1,930 |
1,560 |
$240K |
| A4335 |
Incontinence supply; miscellaneous |
6,727 |
5,757 |
$213K |
| E1399 |
Durable medical equipment, miscellaneous |
1,090 |
961 |
$140K |
| 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 |
1,053 |
871 |
$139K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
576 |
546 |
$117K |
| 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 |
134 |
122 |
$66K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
1,148 |
919 |
$41K |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
54 |
50 |
$33K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
674 |
637 |
$31K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
2,445 |
1,989 |
$28K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
453 |
449 |
$25K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,626 |
1,427 |
$22K |
| A4312 |
Insertion tray without drainage bag with indwelling catheter, foley type, two-way, all silicone |
612 |
584 |
$19K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
1,898 |
1,859 |
$19K |
| A4452 |
Tape, waterproof, per 18 square inches |
369 |
348 |
$18K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
1,308 |
1,014 |
$12K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
759 |
665 |
$9K |
| B9002 |
Enteral nutrition infusion pump, any type |
158 |
141 |
$8K |
| A6210 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
12 |
12 |
$8K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
265 |
222 |
$8K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
24 |
24 |
$6K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
141 |
135 |
$2K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
18 |
18 |
$2K |
| A4456 |
Adhesive remover, wipes, any type, each |
239 |
199 |
$2K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
16 |
13 |
$1K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
12 |
12 |
$1K |
| B9998 |
Noc for enteral supplies |
53 |
36 |
$901.50 |