| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,640 |
1,563 |
$145K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,627 |
1,554 |
$124K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,564 |
1,515 |
$78K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,070 |
1,022 |
$71K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
1,232 |
1,178 |
$55K |
| 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 |
534 |
498 |
$55K |
| A4554 |
Disposable underpads, all sizes |
899 |
876 |
$36K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
491 |
432 |
$35K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
398 |
389 |
$34K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
172 |
158 |
$25K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
268 |
246 |
$22K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
235 |
216 |
$18K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
237 |
218 |
$18K |
| A4927 |
Gloves, non-sterile, per 100 |
1,000 |
961 |
$16K |
| A4335 |
Incontinence supply; miscellaneous |
278 |
276 |
$11K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
133 |
128 |
$7K |
| 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 |
44 |
38 |
$5K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
75 |
73 |
$5K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
54 |
53 |
$284.60 |
| A4245 |
Alcohol wipes, per box |
12 |
12 |
$54.50 |