| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
6,869 |
5,917 |
$3.88M |
| A5120 |
Skin barrier, wipes or swabs, each |
89,472 |
23,221 |
$2.39M |
| 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 |
2,965 |
2,685 |
$978K |
| A4554 |
Disposable underpads, all sizes |
14,807 |
14,252 |
$941K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
12,616 |
12,007 |
$903K |
| A4927 |
Gloves, non-sterile, per 100 |
24,593 |
21,757 |
$725K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
4,093 |
3,901 |
$661K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
4,626 |
4,389 |
$594K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
5,663 |
5,489 |
$400K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
2,265 |
2,124 |
$360K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
22,295 |
19,710 |
$305K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,689 |
1,618 |
$168K |
| 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 |
573 |
554 |
$109K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
293 |
284 |
$70K |
| A4670 |
Automatic blood pressure monitor |
108 |
102 |
$7K |
| E0242 |
Bath tub rail, floor base |
84 |
63 |
$7K |
| K0001 |
Standard wheelchair |
639 |
472 |
$5K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
24 |
24 |
$3K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
25 |
24 |
$2K |
| E0245 |
Tub stool or bench |
48 |
40 |
$2K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
14 |
14 |
$2K |
| E0570 |
Nebulizer, with compressor |
83 |
58 |
$1K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
50 |
41 |
$836.96 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
73 |
60 |
$155.17 |