| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4927 |
Gloves, non-sterile, per 100 |
4,139 |
4,022 |
$68K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
527 |
511 |
$53K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
439 |
422 |
$48K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,255 |
1,210 |
$46K |
| 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 |
328 |
310 |
$46K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
449 |
430 |
$44K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
396 |
387 |
$35K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
143 |
140 |
$35K |
| 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 |
262 |
244 |
$34K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
328 |
316 |
$32K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
612 |
585 |
$27K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
135 |
123 |
$23K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
168 |
164 |
$19K |
| B9998 |
Noc for enteral supplies |
306 |
273 |
$12K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
442 |
178 |
$11K |
| 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 |
74 |
50 |
$9K |
| A4217 |
Sterile water/saline, 500 ml |
114 |
112 |
$4K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
392 |
349 |
$3K |
| A7526 |
Tracheostomy tube collar/holder, each |
56 |
49 |
$1K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
175 |
175 |
$843.07 |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
14 |
12 |
$689.30 |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
19 |
14 |
$508.00 |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
13 |
13 |
$110.70 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
24 |
24 |
$108.00 |