| 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 |
10,195 |
9,288 |
$8.80M |
| A4554 |
Disposable underpads, all sizes |
7,154 |
6,955 |
$1.10M |
| 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 |
1,867 |
1,745 |
$548K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
3,093 |
2,960 |
$306K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,008 |
966 |
$257K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
2,929 |
2,839 |
$175K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
1,499 |
1,445 |
$139K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
583 |
570 |
$71K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
394 |
381 |
$59K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
649 |
645 |
$23K |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
528 |
525 |
$19K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
120 |
117 |
$19K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
143 |
143 |
$17K |
| V5266 |
Battery for use in hearing device |
602 |
289 |
$17K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
118 |
117 |
$15K |
| A4928 |
Surgical mask, per 20 |
74 |
70 |
$10K |
| A4322 |
Irrigation syringe, bulb or piston, each |
231 |
221 |
$9K |
| A4657 |
Syringe, with or without needle, each |
159 |
152 |
$9K |
| B9002 |
Enteral nutrition infusion pump, any type |
36 |
36 |
$7K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
62 |
61 |
$6K |
| A4927 |
Gloves, non-sterile, per 100 |
2,989 |
2,957 |
$5K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
360 |
340 |
$3K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
67 |
66 |
$3K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
36 |
36 |
$2K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
13 |
12 |
$2K |
| A4452 |
Tape, waterproof, per 18 square inches |
50 |
49 |
$451.35 |