| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4152 |
Ef calorie dense>/=1.5kcal |
6,834 |
2,603 |
$187K |
| A4554 |
Disposable underpads |
5,199 |
5,012 |
$162K |
| X1939 |
|
2,524 |
2,434 |
$147K |
| T4534 |
Youth size pull-on |
1,147 |
1,100 |
$122K |
| T5999 |
Supply, nos |
11,352 |
10,432 |
$106K |
| B4154 |
Ef spec metabolic noninherit |
2,304 |
1,046 |
$103K |
| T4543 |
Adult disp brief/diap abv xl |
703 |
670 |
$85K |
| T4527 |
Adult size pull-on lg |
1,597 |
1,523 |
$78K |
| B4035 |
Enteral feed supp pump per d |
2,753 |
1,126 |
$76K |
| T4528 |
Adult size pull-on xl |
1,186 |
1,163 |
$74K |
| T4526 |
Adult size pull-on med |
1,377 |
1,335 |
$68K |
| T4535 |
Disposable liner/shield/pad |
1,962 |
1,883 |
$55K |
| X1915 |
|
459 |
431 |
$37K |
| T4523 |
Adult size brief/diaper lg |
557 |
494 |
$36K |
| X1922 |
|
283 |
239 |
$36K |
| T4524 |
Adult size brief/diaper xl |
410 |
358 |
$30K |
| T4522 |
Adult size brief/diaper med |
474 |
412 |
$28K |
| B4150 |
Ef complet w/intact nutrient |
1,234 |
568 |
$25K |
| A4927 |
Non-sterile gloves |
1,617 |
1,081 |
$23K |
| B4034 |
Enter feed supkit syr by day |
1,262 |
595 |
$20K |
| T4525 |
Adult size pull-on sm |
335 |
314 |
$19K |
| B9002 |
Enter nutr inf pump any type |
1,039 |
435 |
$18K |
| T4533 |
Youth size brief/diaper |
178 |
167 |
$14K |
| A4357 |
Bedside drainage bag |
3,482 |
1,412 |
$8K |
| A4314 |
Cath w/drainage 2-way latex |
1,304 |
471 |
$6K |
| A4333 |
Urinary cath anchor device |
1,504 |
570 |
$5K |
| A4338 |
Indwelling catheter latex |
2,168 |
826 |
$4K |
| A5063 |
Drain ostomy pouch w/flange |
440 |
237 |
$3K |
| A4310 |
Insert tray w/o bag/cath |
2,311 |
895 |
$2K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
229 |
151 |
$2K |
| E0776 |
Iv pole |
480 |
270 |
$1K |
| B4087 |
Gastro/jejuno tube, std |
171 |
80 |
$858.31 |
| A4425 |
Ost pch drain for barrier fl |
133 |
95 |
$799.93 |
| A4409 |
Ost skn barr convex <=4 sq i |
41 |
24 |
$267.81 |