| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4335 |
Incontinence supply; miscellaneous |
6,225 |
6,082 |
$778K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,703 |
2,662 |
$390K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,569 |
1,545 |
$170K |
| A4927 |
Gloves, non-sterile, per 100 |
6,482 |
6,376 |
$110K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
554 |
546 |
$85K |
| T4541 |
Incontinence product, disposable underpad, large, each |
5,652 |
5,517 |
$71K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
270 |
263 |
$31K |
| 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 |
193 |
180 |
$13K |
| 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 |
245 |
233 |
$7K |
| B4100 |
Food thickener, administered orally, per ounce |
174 |
161 |
$3K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
12 |
12 |
$1K |
| 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 |
25 |
24 |
$0.00 |