| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
1,407 |
1,378 |
$392K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
961 |
935 |
$207K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,095 |
1,086 |
$161K |
| A4554 |
Disposable underpads, all sizes |
4,546 |
4,449 |
$159K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
469 |
449 |
$62K |
| 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 |
111 |
105 |
$30K |
| A4335 |
Incontinence supply; miscellaneous |
4,785 |
4,684 |
$25K |
| 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 |
13 |
12 |
$7K |
| A4927 |
Gloves, non-sterile, per 100 |
986 |
977 |
$7K |