| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
2,100 |
2,042 |
$528K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,349 |
2,267 |
$383K |
| 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 |
1,826 |
1,752 |
$371K |
| A4554 |
Disposable underpads, all sizes |
4,898 |
4,727 |
$303K |
| A4927 |
Gloves, non-sterile, per 100 |
4,808 |
4,636 |
$105K |
| A4335 |
Incontinence supply; miscellaneous |
4,590 |
4,444 |
$36K |
| A4452 |
Tape, waterproof, per 18 square inches |
14 |
13 |
$296.00 |