| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
9,920 |
9,160 |
$5.26M |
| 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 |
12,138 |
11,434 |
$2.62M |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
2,420 |
1,602 |
$1.03M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
8,327 |
7,891 |
$718K |
| T5999 |
Supply, not otherwise specified |
6,054 |
5,695 |
$646K |
| B9998 |
Noc for enteral supplies |
4,961 |
3,537 |
$625K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
6,278 |
5,917 |
$518K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
5,071 |
4,807 |
$443K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
3,202 |
3,062 |
$369K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
3,693 |
3,437 |
$327K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
10,132 |
9,489 |
$314K |
| 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 |
2,076 |
1,907 |
$281K |
| T4541 |
Incontinence product, disposable underpad, large, each |
12,657 |
11,736 |
$273K |
| B4100 |
Food thickener, administered orally, per ounce |
1,930 |
1,783 |
$255K |
| A4927 |
Gloves, non-sterile, per 100 |
10,356 |
9,338 |
$230K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
2,278 |
2,145 |
$193K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
2,638 |
2,447 |
$163K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
698 |
575 |
$153K |
| A4335 |
Incontinence supply; miscellaneous |
354 |
285 |
$124K |
| A4649 |
Surgical supply; miscellaneous |
340 |
168 |
$68K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
2,693 |
1,643 |
$53K |
| B4158 |
Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
169 |
140 |
$49K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
651 |
615 |
$44K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
2,600 |
2,491 |
$42K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
429 |
349 |
$31K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
385 |
246 |
$24K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
218 |
206 |
$22K |
| 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 |
143 |
136 |
$18K |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
596 |
578 |
$16K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
201 |
198 |
$16K |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
124 |
105 |
$10K |
| A4322 |
Irrigation syringe, bulb or piston, each |
228 |
197 |
$9K |
| A5120 |
Skin barrier, wipes or swabs, each |
1,215 |
881 |
$5K |
| A4452 |
Tape, waterproof, per 18 square inches |
201 |
144 |
$4K |
| A4456 |
Adhesive remover, wipes, any type, each |
683 |
521 |
$4K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
12 |
12 |
$2K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
394 |
225 |
$2K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
12 |
12 |
$2K |