| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
3,505 |
3,379 |
$165K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,653 |
1,588 |
$135K |
| T4541 |
Incontinence product, disposable underpad, large, each |
3,629 |
3,464 |
$128K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,366 |
1,301 |
$108K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,381 |
1,306 |
$92K |
| A4927 |
Gloves, non-sterile, per 100 |
4,180 |
4,030 |
$64K |
| 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 |
179 |
88 |
$10K |
| 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 |
17 |
15 |
$2K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
31 |
30 |
$2K |