| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
25,881 |
23,390 |
$2.77M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
21,965 |
19,851 |
$2.19M |
| A4927 |
Gloves, non-sterile, per 100 |
67,649 |
60,970 |
$2.18M |
| A4554 |
Disposable underpads, all sizes |
47,971 |
42,721 |
$1.60M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
12,934 |
11,872 |
$1.35M |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
2,855 |
2,573 |
$390K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
2,643 |
2,433 |
$321K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
2,291 |
2,086 |
$269K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,760 |
1,479 |
$158K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,303 |
1,216 |
$144K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,267 |
2,231 |
$96K |
| 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 |
3,475 |
1,790 |
$76K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
440 |
367 |
$69K |
| 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 |
973 |
563 |
$42K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,069 |
1,015 |
$36K |
| K0001 |
Standard wheelchair |
4,121 |
2,505 |
$25K |
| T5999 |
Supply, not otherwise specified |
3,525 |
3,186 |
$19K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
1,568 |
1,548 |
$15K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
3,058 |
2,685 |
$11K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
785 |
471 |
$9K |
| B9002 |
Enteral nutrition infusion pump, any type |
298 |
182 |
$3K |
| E0184 |
Dry pressure mattress |
24 |
22 |
$844.78 |
| A4256 |
Normal, low and high calibrator solution / chips |
1,847 |
1,216 |
$764.11 |
| A4259 |
Lancets, per box of 100 |
2,395 |
1,650 |
$675.22 |
| E0776 |
Iv pole |
429 |
310 |
$535.03 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
47 |
26 |
$332.51 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
15 |
12 |
$214.03 |
| E0607 |
Home blood glucose monitor |
26 |
15 |
$115.98 |