| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
15,658 |
13,981 |
$514K |
| T5999 |
Supply, not otherwise specified |
33,566 |
24,252 |
$385K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
233 |
193 |
$276K |
| X1922 |
|
975 |
915 |
$256K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
4,671 |
3,764 |
$256K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
3,459 |
2,708 |
$241K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
1,937 |
1,837 |
$234K |
| A4927 |
Gloves, non-sterile, per 100 |
15,318 |
9,482 |
$178K |
| X1939 |
|
2,551 |
2,518 |
$155K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
2,604 |
1,979 |
$154K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,449 |
1,431 |
$153K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
3,045 |
2,566 |
$152K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
1,020 |
789 |
$140K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,993 |
1,380 |
$139K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
4,259 |
3,950 |
$131K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,771 |
1,507 |
$105K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
1,148 |
787 |
$95K |
| X1915 |
|
843 |
830 |
$91K |
| 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 |
690 |
646 |
$66K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
950 |
741 |
$23K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
335 |
208 |
$4K |