| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
578 |
561 |
$109K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
309 |
289 |
$80K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
393 |
380 |
$33K |
| T4541 |
Incontinence product, disposable underpad, large, each |
737 |
715 |
$29K |
| 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 |
182 |
175 |
$27K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
113 |
103 |
$17K |
| A4927 |
Gloves, non-sterile, per 100 |
276 |
251 |
$5K |
| 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 |
32 |
26 |
$4K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
12 |
12 |
$2K |