| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4158 |
Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
1,840 |
1,753 |
$587K |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
217 |
214 |
$69K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
222 |
218 |
$38K |
| A4554 |
Disposable underpads, all sizes |
418 |
413 |
$36K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
48 |
48 |
$15K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
79 |
79 |
$14K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
68 |
68 |
$2K |