| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,179 |
2,150 |
$110K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,006 |
1,004 |
$104K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
907 |
906 |
$77K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,557 |
1,557 |
$55K |
| A4927 |
Gloves, non-sterile, per 100 |
2,873 |
2,870 |
$42K |
| 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 |
304 |
304 |
$35K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
247 |
247 |
$29K |
| E1399 |
Durable medical equipment, miscellaneous |
460 |
458 |
$12K |
| E0570 |
Nebulizer, with compressor |
67 |
67 |
$3K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
12 |
12 |
$282.06 |