| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4927 |
Gloves, non-sterile, per 100 |
6,998 |
6,207 |
$105K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,239 |
1,078 |
$102K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,036 |
901 |
$100K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,687 |
1,522 |
$62K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
266 |
241 |
$30K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
652 |
540 |
$24K |
| 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 |
356 |
280 |
$23K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
130 |
111 |
$13K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
128 |
108 |
$6K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
15 |
14 |
$4K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
13 |
12 |
$2K |