| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4534 |
Youth size pull-on |
14,727 |
12,833 |
$2.37M |
| A6021 |
Collagen dressing <=16 sq in |
4,707 |
4,212 |
$1.44M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
11,078 |
6,942 |
$1.43M |
| A6196 |
Alginate dressing <=16 sq in |
10,493 |
9,034 |
$1.39M |
| A6197 |
Alginate drsg >16 <=48 sq in |
3,261 |
2,861 |
$1.07M |
| A6212 |
Foam drg <=16 sq in w/border |
5,719 |
4,909 |
$822K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
10,344 |
9,134 |
$788K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
2,308 |
1,973 |
$618K |
| T4532 |
Ped size pull-on lg |
3,370 |
3,060 |
$564K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
2,418 |
2,113 |
$522K |
| T4533 |
Youth size brief/diaper |
5,186 |
4,338 |
$505K |
| B4150 |
Ef complet w/intact nutrient |
6,336 |
4,109 |
$496K |
| B4035 |
Enteral feed supp pump per d |
3,576 |
3,177 |
$481K |
| T4526 |
Adult size pull-on med |
3,003 |
2,611 |
$406K |
| T4527 |
Adult size pull-on lg |
2,844 |
2,424 |
$401K |
| A6402 |
Sterile gauze <= 16 sq in |
22,503 |
19,696 |
$381K |
| A4351 |
Straight tip urine catheter |
3,376 |
3,046 |
$365K |
| B4152 |
Ef calorie dense>/=1.5kcal |
3,652 |
2,574 |
$352K |
| T4522 |
Adult size brief/diaper med |
3,020 |
2,552 |
$317K |
| B4161 |
Ef ped hydrolyzed/amino acid |
427 |
322 |
$289K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
2,400 |
2,159 |
$275K |
| A4624 |
Tracheal suction tube |
2,285 |
2,044 |
$275K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
1,057 |
946 |
$273K |
| A6446 |
Conform band s w>=3" <5"/yd |
10,070 |
9,357 |
$267K |
| A4629 |
Tracheostomy care kit |
4,508 |
3,266 |
$262K |
| T4521 |
Adult size brief/diaper sm |
2,957 |
2,487 |
$261K |
| T4530 |
Ped size brief/diaper lg |
2,799 |
2,352 |
$246K |
| T4523 |
Adult size brief/diaper lg |
1,862 |
1,497 |
$245K |
| A4452 |
Waterproof tape |
10,303 |
9,439 |
$223K |
| A4623 |
Tracheostomy inner cannula |
2,647 |
2,370 |
$207K |
| B4034 |
Enter feed supkit syr by day |
2,767 |
2,518 |
$206K |
| A6260 |
Wound cleanser any type/size |
13,326 |
12,319 |
$172K |
| T4528 |
Adult size pull-on xl |
979 |
845 |
$172K |
| A6266 |
Impreg gauze no h20/sal/yard |
1,747 |
1,586 |
$163K |
| T4525 |
Adult size pull-on sm |
1,299 |
1,154 |
$163K |
| A4409 |
Ost skn barr convex <=4 sq i |
2,796 |
2,659 |
$157K |
| B9998 |
Enteral supp not otherwise c |
3,917 |
3,013 |
$151K |
| A4385 |
Ost skn barrier sld ext wear |
2,832 |
2,675 |
$140K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
3,595 |
3,050 |
$139K |
| A4425 |
Ost pch drain for barrier fl |
3,373 |
3,238 |
$103K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
2,161 |
2,046 |
$94K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
1,504 |
1,214 |
$90K |
| A4362 |
Solid skin barrier |
2,803 |
2,649 |
$88K |
| T4543 |
Adult disp brief/diap abv xl |
406 |
357 |
$78K |
| A4554 |
Disposable underpads |
1,725 |
1,512 |
$74K |
| A6199 |
Alginate drsg wound filler |
810 |
737 |
$74K |
| A4407 |
Ext wear ost skn barr <=4sq" |
1,160 |
1,122 |
$71K |
| A4927 |
Non-sterile gloves |
11,011 |
10,384 |
$66K |
| A4450 |
Non-waterproof tape |
9,498 |
8,721 |
$64K |
| A7520 |
Trach/laryn tube non-cuffed |
2,311 |
2,070 |
$63K |
| A5063 |
Drain ostomy pouch w/flange |
2,570 |
2,423 |
$62K |
| A5061 |
Pouch drainable w barrier at |
1,577 |
1,509 |
$61K |
| A5120 |
Skin barrier, wipe or swab |
11,901 |
11,188 |
$58K |
| A4424 |
Ost pch drain w bar & filter |
949 |
902 |
$53K |
| A4357 |
Bedside drainage bag |
5,555 |
5,111 |
$50K |
| A6219 |
Gauze <= 16 sq in w/border |
3,248 |
2,633 |
$47K |
| A4406 |
Pectin based ostomy paste |
4,511 |
4,286 |
$45K |
| A4456 |
Adhesive remover, wipes |
7,582 |
7,243 |
$44K |
| A6216 |
Non-sterile gauze<=16 sq in |
4,704 |
4,285 |
$43K |
| T4535 |
Disposable liner/shield/pad |
1,315 |
1,185 |
$41K |
| A9900 |
Supply/accessory/service |
1,486 |
880 |
$40K |
| A4349 |
Disposable male external cat |
1,635 |
1,523 |
$40K |
| A7000 |
Disposable canister for pump |
3,111 |
2,807 |
$36K |
| B4154 |
Ef spec metabolic noninherit |
392 |
201 |
$34K |
| A4332 |
Lube sterile packet |
2,386 |
2,038 |
$30K |
| A7526 |
Tracheostomy tube collar |
3,552 |
3,334 |
$26K |
| A4388 |
Drainable pch w ex wear barr |
527 |
515 |
$22K |
| A6248 |
Hydrogel drsg gel filler |
502 |
475 |
$22K |
| A4358 |
Urinary leg or abdomen bag |
3,426 |
3,242 |
$22K |
| A4483 |
Moisture exchanger |
378 |
320 |
$19K |
| A4338 |
Indwelling catheter latex |
1,971 |
1,790 |
$17K |
| A4320 |
Irrigation tray |
2,167 |
2,039 |
$16K |
| A4628 |
Oropharyngeal suction cath |
2,212 |
2,010 |
$14K |
| E2402 |
Neg press wound therapy pump |
15 |
14 |
$13K |
| T4531 |
Ped size pull-on sm/med |
91 |
80 |
$12K |
| B4088 |
Gastro/jejuno tube, low-pro |
316 |
288 |
$11K |
| A4310 |
Insert tray w/o bag/cath |
2,300 |
2,143 |
$10K |
| A6220 |
Gauze >16 <=48 sq in w/bordr |
223 |
196 |
$10K |
| A7002 |
Tubing used w suction pump |
3,168 |
2,841 |
$9K |
| L8501 |
Tracheostomy speaking valve |
125 |
118 |
$8K |
| A4371 |
Skin barrier powder per oz |
3,810 |
3,627 |
$8K |
| A4394 |
Ostomy pouch liq deodorant |
1,112 |
1,084 |
$5K |
| A4311 |
Catheter w/o bag 2-way latex |
272 |
268 |
$3K |
| A4367 |
Ostomy belt |
1,059 |
1,026 |
$3K |
| A4217 |
Sterile water/saline, 500 ml |
626 |
596 |
$2K |
| T4524 |
Adult size brief/diaper xl |
12 |
12 |
$2K |
| A6550 |
Neg pres wound ther drsg set |
14 |
12 |
$2K |
| A4410 |
Ost skn barr extnd >4 sq |
14 |
12 |
$1K |
| A4389 |
Drainable pch w st wear barr |
24 |
24 |
$1K |
| A4432 |
Os pch urine w bar/fange/tap |
51 |
50 |
$1K |
| A4344 |
Cath indw foley 2 way silicn |
62 |
60 |
$1K |
| A7003 |
Nebulizer administration set |
181 |
156 |
$640.14 |
| A5056 |
1 pc ost pouch w filter |
50 |
50 |
$636.76 |
| A4331 |
Extension drainage tubing |
128 |
100 |
$134.06 |
| A7525 |
Tracheostomy mask |
72 |
53 |
$78.68 |