| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
4,867 |
4,591 |
$531K |
| 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 |
2,214 |
2,047 |
$320K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
900 |
841 |
$224K |
| T4541 |
Incontinence product, disposable underpad, large, each |
3,375 |
3,198 |
$133K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
814 |
711 |
$67K |
| E0570 |
Nebulizer, with compressor |
828 |
797 |
$25K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
517 |
504 |
$23K |
| A4927 |
Gloves, non-sterile, per 100 |
1,552 |
1,453 |
$22K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
249 |
220 |
$21K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
131 |
124 |
$13K |
| 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 |
43 |
38 |
$6K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,086 |
995 |
$4K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
146 |
82 |
$4K |
| A4670 |
Automatic blood pressure monitor |
75 |
74 |
$3K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
40 |
38 |
$3K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
29 |
25 |
$3K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
32 |
25 |
$2K |
| A5513 |
For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
44 |
25 |
$1K |
| A5514 |
For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
24 |
12 |
$488.40 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
14 |
13 |
$118.80 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
41 |
40 |
$106.63 |
| A4259 |
Lancets, per box of 100 |
31 |
27 |
$17.82 |