| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
17,107 |
16,793 |
$587K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
5,653 |
5,575 |
$553K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
14,214 |
14,054 |
$526K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
4,636 |
4,611 |
$390K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
2,849 |
2,806 |
$309K |
| A4335 |
Incontinence supply; miscellaneous |
23,912 |
23,465 |
$131K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,177 |
1,154 |
$105K |
| 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 |
500 |
465 |
$72K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
550 |
537 |
$55K |
| 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 |
136 |
129 |
$52K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
136 |
134 |
$10K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
40 |
39 |
$5K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
554 |
507 |
$3K |
| K0001 |
Standard wheelchair |
118 |
116 |
$1K |
| A4259 |
Lancets, per box of 100 |
508 |
488 |
$372.09 |