| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
729 |
725 |
$111K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
809 |
809 |
$81K |
| A4554 |
Disposable underpads, all sizes |
2,271 |
2,267 |
$79K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
561 |
561 |
$71K |
| 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 |
504 |
502 |
$67K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
422 |
422 |
$34K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
236 |
236 |
$28K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
293 |
293 |
$25K |
| 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 |
291 |
290 |
$23K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
218 |
218 |
$21K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
159 |
158 |
$17K |
| A4927 |
Gloves, non-sterile, per 100 |
996 |
994 |
$14K |
| E0570 |
Nebulizer, with compressor |
145 |
145 |
$11K |
| A4670 |
Automatic blood pressure monitor |
67 |
67 |
$2K |
| E0245 |
Tub stool or bench |
12 |
12 |
$868.00 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
13 |
13 |
$492.34 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
118 |
118 |
$131.58 |
| A7015 |
Aerosol mask, used with dme nebulizer |
118 |
118 |
$116.00 |
| E0156 |
Seat attachment, walker |
13 |
13 |
$93.47 |