| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
6,793 |
6,114 |
$371K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,697 |
2,487 |
$312K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,201 |
2,048 |
$230K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,730 |
1,612 |
$208K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,078 |
992 |
$130K |
| A4927 |
Gloves, non-sterile, per 100 |
2,005 |
1,782 |
$51K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
277 |
264 |
$36K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
525 |
485 |
$32K |
| 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 |
121 |
87 |
$8K |
| E0570 |
Nebulizer, with compressor |
13 |
12 |
$1K |