| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
2,150 |
2,040 |
$461K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
4,519 |
4,131 |
$423K |
| 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 |
4,152 |
3,754 |
$329K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
3,211 |
2,952 |
$321K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
9,593 |
8,803 |
$318K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
3,327 |
3,018 |
$282K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
6,014 |
5,624 |
$273K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
5,037 |
4,772 |
$201K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
574 |
554 |
$168K |
| A4927 |
Gloves, non-sterile, per 100 |
8,245 |
7,614 |
$114K |
| 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 |
788 |
743 |
$81K |
| E0570 |
Nebulizer, with compressor |
2,009 |
1,878 |
$66K |
| 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 |
481 |
455 |
$66K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
597 |
544 |
$54K |
| A4670 |
Automatic blood pressure monitor |
1,108 |
1,065 |
$41K |
| K0001 |
Standard wheelchair |
1,246 |
1,177 |
$35K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
231 |
200 |
$23K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
109 |
99 |
$9K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
72 |
67 |
$5K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
175 |
168 |
$5K |
| E0245 |
Tub stool or bench |
128 |
123 |
$4K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
28 |
26 |
$2K |
| T4541 |
Incontinence product, disposable underpad, large, each |
48 |
44 |
$2K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
418 |
402 |
$1K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
14 |
14 |
$952.38 |
| E0156 |
Seat attachment, walker |
115 |
110 |
$865.83 |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
32 |
25 |
$760.74 |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
12 |
12 |
$690.00 |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
19 |
18 |
$595.56 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
20 |
12 |
$130.21 |