| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
3,193 |
2,811 |
$288K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,890 |
1,664 |
$198K |
| A4554 |
Disposable underpads, all sizes |
7,495 |
6,553 |
$151K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,760 |
1,538 |
$135K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
1,107 |
967 |
$129K |
| 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 |
1,865 |
1,112 |
$78K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,701 |
1,719 |
$57K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
9,276 |
8,193 |
$54K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
422 |
317 |
$45K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
471 |
402 |
$42K |
| A4927 |
Gloves, non-sterile, per 100 |
5,494 |
4,804 |
$36K |
| 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 |
976 |
597 |
$36K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
349 |
248 |
$17K |
| 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 |
939 |
575 |
$2K |
| A4335 |
Incontinence supply; miscellaneous |
5,819 |
5,200 |
$223.16 |
| E0776 |
Iv pole |
107 |
41 |
$141.56 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
36 |
35 |
$0.00 |