| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2028 |
Specialized supply, not otherwise specified, waiver |
2,173 |
1,819 |
$271K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,294 |
1,239 |
$143K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,335 |
1,277 |
$135K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,356 |
1,295 |
$114K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,405 |
1,307 |
$106K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,154 |
1,117 |
$64K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
647 |
628 |
$47K |
| A4927 |
Gloves, non-sterile, per 100 |
1,782 |
1,680 |
$30K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,314 |
1,272 |
$30K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
113 |
86 |
$25K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
172 |
165 |
$6K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
37 |
36 |
$4K |
| 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 |
17 |
12 |
$3K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
17 |
13 |
$144.16 |