| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4534 |
Youth size pull-on |
2,306 |
1,239 |
$209K |
| A4385 |
Ost skn barrier sld ext wear |
2,742 |
1,498 |
$97K |
| A4456 |
Adhesive remover, wipes |
3,716 |
2,150 |
$28K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
300 |
162 |
$22K |
| A4425 |
Ost pch drain for barrier fl |
744 |
449 |
$19K |
| A5120 |
Skin barrier, wipe or swab |
3,740 |
2,196 |
$13K |
| A4406 |
Pectin based ostomy paste |
2,102 |
1,323 |
$12K |
| A4424 |
Ost pch drain w bar & filter |
142 |
127 |
$9K |
| T4535 |
Disposable liner/shield/pad |
50 |
38 |
$2K |
| A4371 |
Skin barrier powder per oz |
355 |
291 |
$976.44 |
| A4415 |
Ost skn barr w/o conv >4 sqi |
15 |
13 |
$827.74 |
| A6216 |
Non-sterile gauze<=16 sq in |
22 |
12 |
$175.96 |