| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
5,929 |
5,740 |
$1.12M |
| 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 |
1,099 |
1,039 |
$1.11M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,733 |
3,553 |
$1.01M |
| 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 |
2,323 |
2,181 |
$816K |
| 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 |
1,832 |
1,714 |
$699K |
| B9998 |
Noc for enteral supplies |
4,710 |
3,952 |
$600K |
| A4554 |
Disposable underpads, all sizes |
6,127 |
5,725 |
$372K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
2,242 |
1,649 |
$348K |
| A4927 |
Gloves, non-sterile, per 100 |
10,016 |
9,683 |
$290K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
2,209 |
2,152 |
$276K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,980 |
1,901 |
$246K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,897 |
1,678 |
$235K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,539 |
1,519 |
$190K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
1,476 |
1,418 |
$184K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
3,566 |
3,340 |
$182K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
1,302 |
1,109 |
$175K |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
5,413 |
5,255 |
$163K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
1,189 |
1,164 |
$122K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
7,208 |
6,944 |
$120K |
| A4553 |
Non-disposable underpads, all sizes |
1,696 |
1,642 |
$104K |
| 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 |
318 |
293 |
$54K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
159 |
106 |
$51K |
| B9002 |
Enteral nutrition infusion pump, any type |
499 |
461 |
$34K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
399 |
381 |
$32K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
168 |
158 |
$30K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
651 |
613 |
$28K |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
88 |
84 |
$21K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
132 |
122 |
$20K |
| A4209 |
Syringe with needle, sterile 5 cc or greater, each |
1,878 |
1,796 |
$18K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
970 |
931 |
$16K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
157 |
157 |
$15K |
| B4103 |
Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
81 |
61 |
$5K |
| A9901 |
Dme delivery, set up, and/or dispensing service component of another hcpcs code |
202 |
113 |
$3K |
| B4104 |
Additive for enteral formula (e.g., fiber) |
45 |
38 |
$3K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
44 |
43 |
$1K |
| A4402 |
Lubricant, per ounce |
83 |
81 |
$736.16 |