| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,145 |
908 |
$106K |
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 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 |
277 |
246 |
$62K |
| A5120 |
Skin barrier, wipes or swabs, each |
1,360 |
1,019 |
$36K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
419 |
325 |
$30K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
315 |
203 |
$21K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
202 |
126 |
$14K |
| T4541 |
Incontinence product, disposable underpad, large, each |
749 |
517 |
$7K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
55 |
48 |
$4K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
13 |
13 |
$1K |