| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,919 |
4,680 |
$1.86M |
| B9998 |
Noc for enteral supplies |
9,954 |
5,071 |
$1.27M |
| B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
1,398 |
1,274 |
$1.18M |
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 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 |
2,505 |
2,055 |
$696K |
| T4541 |
Incontinence product, disposable underpad, large, each |
8,372 |
8,068 |
$479K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,903 |
1,832 |
$395K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
2,074 |
1,986 |
$393K |
| A4927 |
Gloves, non-sterile, per 100 |
11,847 |
11,079 |
$370K |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
2,070 |
1,995 |
$341K |
| 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 |
1,148 |
865 |
$340K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,884 |
1,771 |
$275K |
| A4312 |
Insertion tray without drainage bag with indwelling catheter, foley type, two-way, all silicone |
1,088 |
1,038 |
$257K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
768 |
734 |
$209K |
| A4606 |
Oxygen probe for use with oximeter device, replacement |
1,618 |
1,405 |
$200K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
657 |
632 |
$170K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,235 |
1,121 |
$157K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
1,069 |
938 |
$156K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
731 |
703 |
$129K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
4,348 |
2,847 |
$86K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
1,695 |
1,560 |
$82K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
564 |
543 |
$79K |
| B4149 |
Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
87 |
64 |
$78K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
313 |
303 |
$58K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
1,107 |
1,011 |
$57K |
| A7001 |
Canister, non-disposable, used with suction pump, each |
1,453 |
1,381 |
$57K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
3,852 |
3,665 |
$52K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
240 |
218 |
$37K |
| A7002 |
Tubing, used with suction pump, each |
1,556 |
1,476 |
$27K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
1,034 |
901 |
$26K |
| B9002 |
Enteral nutrition infusion pump, any type |
18 |
18 |
$25K |
| A4322 |
Irrigation syringe, bulb or piston, each |
113 |
111 |
$11K |
| A4657 |
Syringe, with or without needle, each |
2,780 |
2,482 |
$10K |
| A6260 |
Wound cleansers, any type, any size |
1,068 |
1,027 |
$10K |
| A4649 |
Surgical supply; miscellaneous |
1,476 |
1,232 |
$8K |
| A7000 |
Canister, disposable, used with suction pump, each |
64 |
57 |
$1K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
84 |
80 |
$1K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
63 |
62 |
$491.84 |
| A4554 |
Disposable underpads, all sizes |
42 |
42 |
$118.40 |
| S8189 |
Tracheostomy supply, not otherwise classified |
17 |
13 |
$92.08 |