| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
7,870 |
5,974 |
$389K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
4,009 |
3,353 |
$301K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
5,424 |
3,844 |
$264K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
5,529 |
4,044 |
$220K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
2,562 |
1,902 |
$189K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
6,848 |
5,049 |
$174K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,722 |
2,695 |
$159K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,201 |
920 |
$92K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
690 |
586 |
$85K |
| 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 |
2,821 |
2,063 |
$80K |
| S9977 |
Meals, per diem, not otherwise specified |
975 |
793 |
$63K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,405 |
1,997 |
$47K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
3,664 |
1,805 |
$41K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
202 |
147 |
$25K |
| 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 |
690 |
465 |
$24K |
| A4335 |
Incontinence supply; miscellaneous |
1,115 |
870 |
$15K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
1,338 |
1,276 |
$11K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
2,141 |
1,930 |
$10K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
114 |
76 |
$6K |
| A4623 |
Tracheostomy, inner cannula |
244 |
222 |
$6K |
| A4927 |
Gloves, non-sterile, per 100 |
90 |
69 |
$1K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
267 |
254 |
$1K |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
482 |
468 |
$843.63 |
| T4542 |
Incontinence product, disposable underpad, small size, each |
16 |
15 |
$519.84 |
| B9002 |
Enteral nutrition infusion pump, any type |
39 |
38 |
$283.00 |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
26 |
24 |
$127.42 |
| A4629 |
Tracheostomy care kit for established tracheostomy |
166 |
156 |
$92.72 |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
14 |
13 |
$51.63 |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
14 |
14 |
$31.49 |
| A7526 |
Tracheostomy tube collar/holder, each |
72 |
69 |
$0.00 |