| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
9,902 |
9,634 |
$3.67M |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
7,485 |
7,366 |
$2.85M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
11,926 |
11,719 |
$2.37M |
| A4554 |
Disposable underpads, all sizes |
12,179 |
11,960 |
$757K |
| A4927 |
Gloves, non-sterile, per 100 |
12,186 |
11,953 |
$302K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
12,186 |
11,954 |
$119K |