| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
10,582 |
9,230 |
$557K |
| 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 |
5,600 |
4,837 |
$546K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
3,967 |
3,471 |
$415K |
| 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 |
2,474 |
2,035 |
$271K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
2,349 |
2,090 |
$270K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
2,393 |
2,100 |
$238K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,742 |
1,387 |
$144K |
| A4927 |
Gloves, non-sterile, per 100 |
4,492 |
3,653 |
$130K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
300 |
245 |
$53K |
| A4670 |
Automatic blood pressure monitor |
466 |
398 |
$25K |
| 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 |
147 |
124 |
$21K |
| A4259 |
Lancets, per box of 100 |
1,674 |
1,387 |
$19K |
| A4244 |
Alcohol or peroxide, per pint |
494 |
426 |
$3K |
| A4258 |
Spring-powered device for lancet, each |
120 |
119 |
$2K |
| A4234 |
Replacement battery, alkaline, j cell, for use with medically necessary home blood glucose monitor owned by patient, each |
501 |
444 |
$1K |
| E0607 |
Home blood glucose monitor |
21 |
20 |
$1K |
| A4335 |
Incontinence supply; miscellaneous |
78 |
75 |
$530.79 |