| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
172,141 |
169,841 |
$9.45M |
| T4523 |
Adult size brief/diaper lg |
70,707 |
69,804 |
$6.57M |
| T4522 |
Adult size brief/diaper med |
59,079 |
58,357 |
$4.14M |
| T4524 |
Adult size brief/diaper xl |
37,381 |
36,866 |
$3.67M |
| T4535 |
Disposable liner/shield/pad |
101,280 |
99,721 |
$3.12M |
| T4543 |
Adult disp brief/diap abv xl |
13,139 |
12,906 |
$2.48M |
| T4537 |
Reusable underpad bed size |
43,888 |
43,322 |
$1.25M |
| B4154 |
Ef spec metabolic noninherit |
7,944 |
7,825 |
$997K |
| E1399 |
Durable medical equipment mi |
6,615 |
5,999 |
$807K |
| A4649 |
Surgical supplies |
11,909 |
11,005 |
$790K |
| B4150 |
Ef complet w/intact nutrient |
8,785 |
8,652 |
$671K |
| A4927 |
Non-sterile gloves |
159,139 |
156,663 |
$659K |
| E0570 |
Nebulizer with compression |
5,428 |
5,402 |
$472K |
| T4527 |
Adult size pull-on lg |
9,718 |
9,582 |
$471K |
| B4152 |
Ef calorie dense>/=1.5kcal |
4,982 |
4,920 |
$442K |
| T4526 |
Adult size pull-on med |
8,351 |
8,225 |
$376K |
| T4521 |
Adult size brief/diaper sm |
5,630 |
5,568 |
$340K |
| E1390 |
Oxygen concentrator |
4,055 |
3,910 |
$310K |
| T4528 |
Adult size pull-on xl |
4,568 |
4,508 |
$268K |
| B9998 |
Enteral supp not otherwise c |
2,087 |
1,997 |
$247K |
| E0143 |
Walker folding wheeled w/o s |
1,950 |
1,923 |
$160K |
| E0260 |
Hosp bed semi-electr w/ matt |
259 |
255 |
$149K |
| K0001 |
Standard wheelchair |
505 |
499 |
$136K |
| A6212 |
Foam drg <=16 sq in w/border |
727 |
669 |
$128K |
| E0431 |
Portable gaseous 02 |
3,485 |
3,301 |
$120K |
| T4539 |
Reuse diaper/brief any size |
4,363 |
4,306 |
$113K |
| A6250 |
Skin seal protect moisturizr |
12,882 |
12,512 |
$104K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,830 |
1,770 |
$98K |
| E0241 |
Bath tub wall rail |
1,913 |
1,871 |
$97K |
| A9270 |
Non-covered item or service |
1,876 |
1,851 |
$85K |
| T4544 |
Adlt disp und/pull on abv xl |
668 |
655 |
$84K |
| A4253 |
Blood glucose/reagent strips |
3,517 |
3,474 |
$84K |
| E0371 |
Nonpower mattress overlay |
116 |
115 |
$77K |
| A4670 |
Automatic bp monitor, dial |
2,063 |
2,055 |
$74K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
1,035 |
1,004 |
$70K |
| A4357 |
Bedside drainage bag |
2,010 |
1,934 |
$67K |
| E0240 |
Bath/shower chair |
2,155 |
2,144 |
$66K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
669 |
618 |
$65K |
| A6402 |
Sterile gauze <= 16 sq in |
4,861 |
4,589 |
$58K |
| A6258 |
Transparent film >16<=48 in |
716 |
643 |
$57K |
| E2603 |
Skin protect wc cus wd <22in |
461 |
457 |
$51K |
| B4155 |
Ef incomplete/modular |
1,181 |
1,155 |
$50K |
| T4540 |
Reusable underpad chair size |
3,291 |
3,243 |
$48K |
| A4349 |
Disposable male external cat |
944 |
896 |
$48K |
| A4335 |
Incontinence supply |
3,368 |
3,284 |
$46K |
| A6197 |
Alginate drsg >16 <=48 sq in |
382 |
347 |
$46K |
| A4358 |
Urinary leg or abdomen bag |
1,429 |
1,392 |
$46K |
| E0163 |
Commode chair with fixed arm |
778 |
770 |
$42K |
| B4100 |
Food thickener oral |
1,760 |
1,724 |
$38K |
| A4351 |
Straight tip urine catheter |
290 |
281 |
$34K |
| A4216 |
Sterile water/saline, 10 ml |
1,681 |
1,524 |
$33K |
| A6446 |
Conform band s w>=3" <5"/yd |
1,492 |
1,452 |
$32K |
| A4353 |
Intermittent urinary cath |
71 |
65 |
$28K |
| A6216 |
Non-sterile gauze<=16 sq in |
2,538 |
2,365 |
$26K |
| E0156 |
Walker seat attachment |
1,492 |
1,479 |
$25K |
| A6196 |
Alginate dressing <=16 sq in |
174 |
151 |
$22K |
| A4217 |
Sterile water/saline, 500 ml |
2,449 |
2,400 |
$18K |
| E1038 |
Transport chair pt wt<=300lb |
138 |
138 |
$16K |
| A4452 |
Waterproof tape |
1,471 |
1,444 |
$16K |
| A4259 |
Lancets per box |
3,016 |
2,992 |
$14K |
| A4245 |
Alcohol wipes per box |
5,108 |
5,062 |
$14K |
| A5063 |
Drain ostomy pouch w/flange |
192 |
190 |
$13K |
| E0971 |
Wheelchair anti-tipping devi |
228 |
226 |
$11K |
| A5120 |
Skin barrier, wipe or swab |
1,045 |
998 |
$10K |
| E0247 |
Trans bench w/wo comm open |
134 |
132 |
$10K |
| A4450 |
Non-waterproof tape |
1,469 |
1,435 |
$10K |
| E0244 |
Toilet seat raised |
496 |
494 |
$9K |
| A4402 |
Lubricant per ounce |
1,275 |
1,264 |
$8K |
| A6403 |
Sterile gauze>16 <= 48 sq in |
376 |
363 |
$6K |
| E0100 |
Cane adjust/fixed with tip |
387 |
387 |
$6K |
| A4320 |
Irrigation tray |
107 |
103 |
$5K |
| A4322 |
Irrigation syringe |
177 |
166 |
$4K |
| A4338 |
Indwelling catheter latex |
216 |
205 |
$4K |
| E2601 |
Gen w/c cushion wdth < 22 in |
98 |
98 |
$4K |
| A4310 |
Insert tray w/o bag/cath |
211 |
201 |
$4K |
| E0315 |
Bed accessory brd/tbl/supprt |
52 |
52 |
$3K |
| E0184 |
Dry pressure mattress |
40 |
40 |
$3K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
12 |
12 |
$3K |
| E0978 |
W/c acc,saf belt pelv strap |
97 |
95 |
$2K |
| E0274 |
Over-bed table |
41 |
41 |
$2K |
| T4533 |
Youth size brief/diaper |
25 |
25 |
$2K |
| E0215 |
Electric heat pad moist |
59 |
59 |
$1K |
| K0195 |
Elevating whlchair leg rests |
13 |
13 |
$1K |
| A6240 |
Hydrocolld drg filler paste |
13 |
13 |
$742.98 |
| A6257 |
Transparent film <= 16 sq in |
30 |
27 |
$726.88 |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
14 |
13 |
$620.58 |
| A6248 |
Hydrogel drsg gel filler |
15 |
15 |
$355.57 |
| E0961 |
Wheelchair brake extension |
12 |
12 |
$234.78 |
| E0951 |
Loop heel |
12 |
12 |
$207.65 |
| A7005 |
Nondisposable nebulizer set |
12 |
12 |
$170.88 |
| A4246 |
Betadine/phisohex solution |
37 |
37 |
$91.90 |
| A6443 |
Conform band n/s w>=3"<5"/yd |
16 |
13 |
$88.58 |