| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,275 |
1,189 |
$156K |
| 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 |
991 |
805 |
$146K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,036 |
1,851 |
$98K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
484 |
445 |
$83K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
173 |
165 |
$75K |
| A4927 |
Gloves, non-sterile, per 100 |
1,923 |
1,765 |
$37K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
260 |
234 |
$37K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
214 |
203 |
$31K |
| 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 |
293 |
239 |
$27K |
| B9998 |
Noc for enteral supplies |
105 |
82 |
$12K |
| A4670 |
Automatic blood pressure monitor |
121 |
117 |
$9K |
| 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 |
16 |
12 |
$2K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
109 |
101 |
$900.15 |