| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4927 |
Gloves, non-sterile, per 100 |
29,468 |
27,641 |
$481K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
3,935 |
3,629 |
$427K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
3,246 |
2,992 |
$365K |
| T4541 |
Incontinence product, disposable underpad, large, each |
9,358 |
8,752 |
$351K |
| 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 |
2,312 |
2,127 |
$280K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,648 |
2,488 |
$258K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
2,390 |
2,183 |
$241K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
2,258 |
2,054 |
$227K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
930 |
834 |
$193K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
3,868 |
3,594 |
$164K |
| 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 |
994 |
916 |
$157K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
824 |
801 |
$100K |
| B9998 |
Noc for enteral supplies |
1,499 |
1,201 |
$72K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
358 |
352 |
$63K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,251 |
695 |
$44K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
220 |
187 |
$20K |
| B4100 |
Food thickener, administered orally, per ounce |
182 |
169 |
$13K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
750 |
740 |
$11K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
55 |
54 |
$6K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
416 |
410 |
$2K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
13 |
12 |
$1K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
13 |
13 |
$36.00 |