| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
14,162 |
13,943 |
$582K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
7,308 |
7,132 |
$455K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
7,338 |
7,276 |
$332K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
11,973 |
11,828 |
$307K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
3,793 |
3,736 |
$250K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
1,432 |
1,348 |
$190K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
6,751 |
6,694 |
$180K |
| A4927 |
Gloves, non-sterile, per 100 |
17,729 |
17,544 |
$68K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
894 |
852 |
$55K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,071 |
1,030 |
$53K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,324 |
1,311 |
$35K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
728 |
722 |
$33K |
| E1399 |
Durable medical equipment, miscellaneous |
856 |
807 |
$30K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
280 |
277 |
$21K |
| B4100 |
Food thickener, administered orally, per ounce |
246 |
231 |
$14K |
| 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 |
184 |
170 |
$13K |
| 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 |
57 |
52 |
$8K |
| A4335 |
Incontinence supply; miscellaneous |
414 |
406 |
$7K |
| A4259 |
Lancets, per box of 100 |
895 |
881 |
$4K |
| 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 |
28 |
26 |
$3K |
| V5266 |
Battery for use in hearing device |
210 |
210 |
$2K |
| A4245 |
Alcohol wipes, per box |
558 |
544 |
$886.97 |
| E0240 |
Bath/shower chair, with or without wheels, any size |
26 |
26 |
$878.16 |
| A4208 |
Syringe with needle, sterile 3 cc, each |
114 |
101 |
$50.61 |