| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
4,369 |
4,206 |
$379K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
4,080 |
3,878 |
$366K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
2,791 |
2,629 |
$258K |
| T4541 |
Incontinence product, disposable underpad, large, each |
5,377 |
5,245 |
$251K |
| A4927 |
Gloves, non-sterile, per 100 |
8,131 |
8,039 |
$204K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
5,701 |
5,493 |
$165K |
| 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 |
1,524 |
1,429 |
$158K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
1,411 |
1,340 |
$134K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
972 |
923 |
$107K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
1,317 |
1,303 |
$76K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
764 |
724 |
$71K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
328 |
315 |
$36K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
940 |
934 |
$35K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
347 |
337 |
$34K |
| A5131 |
Appliance cleaner, incontinence and ostomy appliances, per 16 oz. |
2,199 |
2,172 |
$26K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
1,464 |
1,432 |
$12K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
122 |
119 |
$10K |
| 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 |
51 |
49 |
$8K |
| A4322 |
Irrigation syringe, bulb or piston, each |
109 |
106 |
$8K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
466 |
459 |
$5K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
588 |
584 |
$4K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
645 |
634 |
$3K |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
857 |
848 |
$2K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
13 |
12 |
$1K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
145 |
139 |
$943.73 |
| A4402 |
Lubricant, per ounce |
165 |
162 |
$674.87 |
| A4245 |
Alcohol wipes, per box |
26 |
24 |
$138.28 |
| A5120 |
Skin barrier, wipes or swabs, each |
13 |
12 |
$125.30 |