| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
17,521 |
12,983 |
$1.51M |
| A4554 |
Disposable underpads, all sizes |
26,861 |
20,978 |
$1.43M |
| 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 |
5,865 |
4,331 |
$1.37M |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
15,121 |
11,366 |
$1.35M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
8,257 |
6,563 |
$1.26M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
17,796 |
13,834 |
$1.22M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
8,366 |
6,619 |
$1.11M |
| 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 |
3,083 |
2,542 |
$856K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
4,678 |
3,609 |
$639K |
| A4927 |
Gloves, non-sterile, per 100 |
27,154 |
19,872 |
$574K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
2,208 |
1,862 |
$412K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
1,673 |
1,241 |
$302K |
| 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 |
2,107 |
1,581 |
$254K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
6,429 |
4,973 |
$196K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
6,559 |
5,063 |
$189K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,432 |
1,194 |
$154K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
945 |
759 |
$77K |
| 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 |
329 |
250 |
$57K |
| B4102 |
Enteral formula, for adults, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
403 |
323 |
$41K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,258 |
1,051 |
$30K |
| A4245 |
Alcohol wipes, per box |
1,772 |
1,445 |
$17K |
| A4452 |
Tape, waterproof, per 18 square inches |
605 |
542 |
$14K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
980 |
863 |
$11K |
| A4259 |
Lancets, per box of 100 |
970 |
844 |
$8K |
| A4670 |
Automatic blood pressure monitor |
142 |
101 |
$7K |
| A6452 |
High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard |
17 |
12 |
$7K |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
715 |
583 |
$5K |
| E1399 |
Durable medical equipment, miscellaneous |
68 |
56 |
$5K |
| A6260 |
Wound cleansers, any type, any size |
209 |
165 |
$3K |
| E0245 |
Tub stool or bench |
51 |
43 |
$2K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
43 |
36 |
$2K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
30 |
29 |
$941.04 |
| A4553 |
Non-disposable underpads, all sizes |
41 |
24 |
$765.10 |
| E0570 |
Nebulizer, with compressor |
32 |
12 |
$677.60 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
80 |
74 |
$648.91 |
| E0241 |
Bath tub wall rail, each |
16 |
14 |
$542.24 |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
107 |
91 |
$354.37 |
| A5120 |
Skin barrier, wipes or swabs, each |
64 |
49 |
$310.61 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
33 |
13 |
$237.03 |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
44 |
38 |
$205.94 |
| A4456 |
Adhesive remover, wipes, any type, each |
13 |
12 |
$80.50 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
12 |
12 |
$66.64 |
| A7015 |
Aerosol mask, used with dme nebulizer |
32 |
12 |
$16.44 |