| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
823 |
811 |
$82K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
860 |
854 |
$71K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
380 |
377 |
$50K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
971 |
955 |
$44K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
461 |
460 |
$44K |
| 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 |
284 |
252 |
$30K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
695 |
688 |
$28K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,226 |
1,204 |
$26K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
103 |
101 |
$24K |
| A4927 |
Gloves, non-sterile, per 100 |
2,328 |
1,413 |
$19K |
| 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 |
110 |
104 |
$18K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
116 |
115 |
$12K |
| B4100 |
Food thickener, administered orally, per ounce |
167 |
153 |
$8K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
26 |
25 |
$3K |
| 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 |
14 |
13 |
$1K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
26 |
25 |
$1K |
| E0570 |
Nebulizer, with compressor |
163 |
158 |
$514.11 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
41 |
37 |
$216.34 |
| A4259 |
Lancets, per box of 100 |
13 |
13 |
$2.52 |