| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
11,917 |
11,091 |
$734K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
18,425 |
16,063 |
$652K |
| A0100 |
Non-emergency transportation; taxi |
6,000 |
5,025 |
$638K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
13,125 |
12,098 |
$638K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
7,939 |
6,669 |
$522K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
5,548 |
5,033 |
$506K |
| 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 |
4,950 |
3,624 |
$444K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
9,798 |
9,038 |
$421K |
| A0090 |
Non-emergency transportation, per mile - vehicle provided by individual (family member, self, neighbor) with vested interest |
3,063 |
2,828 |
$242K |
| 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 |
2,029 |
1,512 |
$226K |
| T2003 |
Non-emergency transportation; encounter/trip |
1,898 |
1,643 |
$219K |
| A0110 |
Non-emergency transportation and bus, intra or inter state carrier |
3,324 |
3,206 |
$173K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
2,003 |
1,643 |
$170K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,784 |
1,649 |
$148K |
| T4541 |
Incontinence product, disposable underpad, large, each |
4,260 |
3,922 |
$110K |
| A4335 |
Incontinence supply; miscellaneous |
7,172 |
6,570 |
$100K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,619 |
1,479 |
$99K |
| A4927 |
Gloves, non-sterile, per 100 |
5,315 |
4,436 |
$80K |
| 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 |
828 |
570 |
$69K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,230 |
1,120 |
$54K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
1,275 |
1,167 |
$45K |
| B4102 |
Enteral formula, for adults, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
723 |
589 |
$43K |
| S0215 |
Non-emergency transportation; mileage, per mile |
368 |
350 |
$36K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
109 |
95 |
$13K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
173 |
161 |
$13K |
| A9150 |
Non-prescription drugs |
389 |
285 |
$3K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
56 |
47 |
$2K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
14 |
12 |
$1K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
98 |
94 |
$1K |
| A4245 |
Alcohol wipes, per box |
446 |
429 |
$1K |
| E0325 |
Urinal; male, jug-type, any material |
458 |
454 |
$1K |
| B4100 |
Food thickener, administered orally, per ounce |
23 |
21 |
$1K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
17 |
17 |
$757.52 |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
14 |
12 |
$180.94 |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
14 |
13 |
$123.76 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
14 |
13 |
$114.00 |