| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
48,114 |
46,026 |
$2.18M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
17,507 |
16,682 |
$1.89M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
17,544 |
16,704 |
$1.68M |
| A4927 |
Gloves, non-sterile, per 100 |
35,008 |
33,509 |
$1.32M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
10,297 |
9,811 |
$1.08M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
8,651 |
8,044 |
$970K |
| 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 |
9,375 |
7,888 |
$896K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
4,833 |
4,614 |
$786K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
5,045 |
4,830 |
$557K |
| 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 |
3,723 |
3,194 |
$468K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
4,012 |
3,788 |
$436K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,945 |
2,762 |
$356K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
3,798 |
3,475 |
$319K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
1,757 |
1,671 |
$270K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,897 |
1,366 |
$269K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
1,968 |
1,844 |
$222K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
5,885 |
5,240 |
$205K |
| 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 |
1,678 |
1,493 |
$148K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
729 |
690 |
$78K |
| 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 |
490 |
404 |
$68K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
1,272 |
919 |
$10K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
141 |
87 |
$3K |
| A4402 |
Lubricant, per ounce |
915 |
703 |
$3K |
| E0570 |
Nebulizer, with compressor |
19 |
14 |
$2K |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
24 |
24 |
$85.61 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
41 |
40 |
$63.23 |