| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
1,540 |
1,282 |
$814K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,769 |
1,467 |
$218K |
| A4554 |
Disposable underpads, all sizes |
3,998 |
3,444 |
$143K |
| A4930 |
Gloves, sterile, per pair |
3,775 |
3,176 |
$98K |
| 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 |
93 |
84 |
$76K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
649 |
463 |
$74K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
153 |
152 |
$17K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
66 |
64 |
$13K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
89 |
88 |
$8K |
| A4322 |
Irrigation syringe, bulb or piston, each |
374 |
277 |
$7K |