| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4927 |
Gloves, non-sterile, per 100 |
30,085 |
27,195 |
$830K |
| A4554 |
Disposable underpads, all sizes |
8,785 |
7,770 |
$497K |
| B4157 |
Enteral formula, nutritionally complete, for special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
765 |
639 |
$482K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,508 |
2,253 |
$369K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,165 |
1,975 |
$301K |
| 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 |
2,491 |
1,886 |
$266K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,557 |
1,314 |
$211K |
| 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 |
389 |
317 |
$162K |
| 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 |
754 |
545 |
$153K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
695 |
624 |
$150K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
361 |
293 |
$73K |
| A4335 |
Incontinence supply; miscellaneous |
8,878 |
7,765 |
$61K |
| A5120 |
Skin barrier, wipes or swabs, each |
423 |
374 |
$2K |