| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
3,500 |
3,449 |
$395K |
| T4541 |
Incontinence product, disposable underpad, large, each |
3,917 |
3,883 |
$293K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,026 |
2,002 |
$267K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,136 |
2,115 |
$240K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,780 |
1,741 |
$211K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,372 |
1,347 |
$183K |
| 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 |
1,009 |
977 |
$157K |
| 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 |
1,088 |
1,073 |
$154K |
| 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 |
906 |
888 |
$141K |
| A4927 |
Gloves, non-sterile, per 100 |
4,610 |
4,536 |
$114K |
| 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 |
324 |
320 |
$100K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
667 |
660 |
$97K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
3,740 |
3,656 |
$86K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
399 |
390 |
$68K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
194 |
186 |
$66K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
413 |
402 |
$56K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
349 |
342 |
$50K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
244 |
240 |
$31K |
| A6252 |
Specialty absorptive 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 |
64 |
64 |
$9K |
| A4554 |
Disposable underpads, all sizes |
239 |
231 |
$7K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
79 |
78 |
$4K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
376 |
346 |
$3K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
30 |
30 |
$3K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
28 |
28 |
$2K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
12 |
12 |
$1K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
161 |
155 |
$1K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
128 |
123 |
$1K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
26 |
25 |
$1K |
| A4402 |
Lubricant, per ounce |
164 |
149 |
$898.64 |
| A5120 |
Skin barrier, wipes or swabs, each |
125 |
101 |
$837.71 |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
13 |
12 |
$719.23 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
12 |
12 |
$710.02 |
| V5266 |
Battery for use in hearing device |
28 |
27 |
$389.99 |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
32 |
26 |
$353.98 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
13 |
13 |
$331.65 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
27 |
27 |
$216.24 |
| A4456 |
Adhesive remover, wipes, any type, each |
28 |
27 |
$206.29 |
| A4245 |
Alcohol wipes, per box |
12 |
12 |
$102.09 |