| 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 |
5,574 |
5,124 |
$3.67M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
10,072 |
8,595 |
$2.17M |
| A6531 |
Gradient compression stocking, below knee, 30-40 mmhg, used as a surgical dressing, each |
8,083 |
6,380 |
$1.97M |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
3,027 |
2,719 |
$1.06M |
| 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 |
1,786 |
1,625 |
$609K |
| A4554 |
Disposable underpads, all sizes |
10,782 |
9,193 |
$603K |
| A4927 |
Gloves, non-sterile, per 100 |
10,869 |
9,267 |
$294K |
| A5120 |
Skin barrier, wipes or swabs, each |
19,247 |
9,349 |
$254K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,247 |
1,013 |
$152K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
10,845 |
9,254 |
$95K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
462 |
359 |
$53K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
168 |
163 |
$41K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,379 |
1,185 |
$17K |
| A4259 |
Lancets, per box of 100 |
1,261 |
1,185 |
$2K |
| A4670 |
Automatic blood pressure monitor |
32 |
25 |
$2K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
49 |
33 |
$572.28 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
43 |
43 |
$0.00 |