| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
3,493 |
2,678 |
$1.05M |
| A4554 |
Disposable underpads, all sizes |
4,491 |
3,646 |
$359K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
2,672 |
2,072 |
$227K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
175 |
165 |
$125K |
| L8000 |
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
739 |
575 |
$28K |
| L8020 |
Breast prosthesis, mastectomy form |
269 |
180 |
$8K |
| L8030 |
Breast prosthesis, silicone or equal, without integral adhesive |
73 |
45 |
$1K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
24 |
24 |
$565.20 |