| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
6,293 |
6,230 |
$684K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,440 |
3,317 |
$620K |
| 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 |
3,108 |
3,025 |
$554K |
| A4554 |
Disposable underpads, all sizes |
11,550 |
11,375 |
$451K |
| B9002 |
Enteral nutrition infusion pump, any type |
3,880 |
3,731 |
$276K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
2,969 |
2,908 |
$242K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
5,528 |
4,986 |
$230K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
2,575 |
2,477 |
$227K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,817 |
1,803 |
$208K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,286 |
1,255 |
$183K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,652 |
1,624 |
$157K |
| A4927 |
Gloves, non-sterile, per 100 |
1,796 |
1,747 |
$126K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
5,879 |
5,035 |
$101K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
1,135 |
1,109 |
$100K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
927 |
921 |
$98K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
949 |
943 |
$95K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
164 |
157 |
$89K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
955 |
932 |
$79K |
| B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
136 |
108 |
$68K |
| 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 |
132 |
129 |
$21K |
| E2103 |
Non-adjunctive, non-implanted continuous glucose monitor or receiver |
503 |
468 |
$17K |
| B4149 |
Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
24 |
24 |
$5K |
| E0776 |
Iv pole |
310 |
299 |
$5K |
| K0554 |
Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system |
200 |
182 |
$4K |