| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
6,864 |
6,754 |
$1.31M |
| 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 |
2,921 |
2,086 |
$488K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
3,688 |
3,588 |
$423K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
2,190 |
2,144 |
$268K |
| 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 |
371 |
363 |
$253K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,362 |
1,343 |
$229K |
| 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 |
2,185 |
1,400 |
$219K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
939 |
918 |
$209K |
| 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 |
509 |
493 |
$171K |
| B9998 |
Noc for enteral supplies |
2,120 |
1,577 |
$158K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
162 |
162 |
$32K |
| 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 |
310 |
187 |
$31K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
739 |
716 |
$25K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
123 |
120 |
$23K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
60 |
60 |
$7K |
| A7000 |
Canister, disposable, used with suction pump, each |
84 |
84 |
$2K |
| A4322 |
Irrigation syringe, bulb or piston, each |
26 |
26 |
$888.36 |
| A7002 |
Tubing, used with suction pump, each |
84 |
84 |
$758.67 |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
109 |
108 |
$600.24 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
12 |
12 |
$298.00 |