| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
28,518 |
28,024 |
$1.29M |
| A4245 |
Alcohol wipes, per box |
86,637 |
85,114 |
$1.08M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
23,561 |
23,202 |
$1.07M |
| A4554 |
Disposable underpads, all sizes |
50,844 |
49,726 |
$923K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
15,639 |
15,364 |
$891K |
| A4927 |
Gloves, non-sterile, per 100 |
64,203 |
62,939 |
$589K |
| A4335 |
Incontinence supply; miscellaneous |
5,724 |
5,597 |
$508K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
7,573 |
7,451 |
$391K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
8,921 |
8,791 |
$384K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
4,166 |
4,081 |
$360K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
5,454 |
5,334 |
$319K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
5,173 |
5,089 |
$280K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
2,695 |
2,617 |
$276K |
| 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 |
1,925 |
1,872 |
$193K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
3,191 |
3,138 |
$177K |
| 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 |
567 |
560 |
$67K |
| 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 |
257 |
253 |
$35K |
| A5120 |
Skin barrier, wipes or swabs, each |
167 |
140 |
$12K |
| S5199 |
Personal care item, nos, each |
532 |
498 |
$9K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
91 |
89 |
$6K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
614 |
606 |
$1K |