| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
1,776 |
1,408 |
$63K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
556 |
524 |
$58K |
| 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 |
437 |
248 |
$28K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
262 |
249 |
$24K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
204 |
193 |
$23K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
1,550 |
547 |
$15K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
1,581 |
560 |
$12K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
200 |
140 |
$10K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
89 |
54 |
$5K |
| A4927 |
Gloves, non-sterile, per 100 |
154 |
139 |
$4K |
| E0570 |
Nebulizer, with compressor |
35 |
29 |
$1K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
163 |
144 |
$506.44 |
| A4259 |
Lancets, per box of 100 |
159 |
141 |
$12.58 |