| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
14,523 |
14,049 |
$9.54M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
27,339 |
26,770 |
$6.38M |
| A4554 |
Disposable underpads |
185,344 |
183,638 |
$6.05M |
| T4527 |
Adult size pull-on lg |
41,501 |
40,983 |
$4.74M |
| T4526 |
Adult size pull-on med |
42,107 |
41,449 |
$3.88M |
| B4035 |
Enteral feed supp pump per d |
15,160 |
13,911 |
$3.77M |
| T4534 |
Youth size pull-on |
38,451 |
37,422 |
$3.53M |
| T4528 |
Adult size pull-on xl |
22,630 |
22,342 |
$3.03M |
| A4335 |
Incontinence supply |
241,206 |
238,908 |
$1.83M |
| T4535 |
Disposable liner/shield/pad |
53,836 |
50,884 |
$1.71M |
| T4544 |
Adlt disp und/pull on abv xl |
8,183 |
8,100 |
$1.55M |
| T4525 |
Adult size pull-on sm |
19,146 |
18,179 |
$1.47M |
| B9998 |
Enteral supp not otherwise c |
20,498 |
16,521 |
$1.38M |
| B4155 |
Ef incomplete/modular |
4,530 |
4,395 |
$1.29M |
| A4351 |
Straight tip urine catheter |
4,424 |
3,960 |
$1.29M |
| T4530 |
Ped size brief/diaper lg |
15,876 |
15,264 |
$1.14M |
| B4150 |
Ef complet w/intact nutrient |
5,341 |
5,139 |
$1.13M |
| B4153 |
Ef hydrolyzed/amino acids |
677 |
585 |
$1.02M |
| T4522 |
Adult size brief/diaper med |
11,222 |
11,037 |
$962K |
| B4149 |
Ef blenderized foods |
2,380 |
2,266 |
$936K |
| T4532 |
Ped size pull-on lg |
7,684 |
7,344 |
$850K |
| T4523 |
Adult size brief/diaper lg |
8,157 |
8,011 |
$724K |
| B4152 |
Ef calorie dense>/=1.5kcal |
2,800 |
2,633 |
$719K |
| T4524 |
Adult size brief/diaper xl |
6,466 |
6,420 |
$706K |
| B4158 |
Ef ped complete intact nut |
2,902 |
2,845 |
$648K |
| B9002 |
Enter nutr inf pump any type |
902 |
873 |
$586K |
| B4154 |
Ef spec metabolic noninherit |
881 |
800 |
$455K |
| B4034 |
Enter feed supkit syr by day |
2,918 |
2,742 |
$349K |
| T4521 |
Adult size brief/diaper sm |
2,854 |
2,731 |
$229K |
| T4543 |
Adult disp brief/diap abv xl |
1,287 |
1,275 |
$178K |
| A4385 |
Ost skn barrier sld ext wear |
2,413 |
2,366 |
$174K |
| A4239 |
Non-adju cgm supply allow |
789 |
787 |
$140K |
| A4409 |
Ost skn barr convex <=4 sq i |
1,267 |
1,211 |
$110K |
| A6212 |
Foam drg <=16 sq in w/border |
556 |
503 |
$85K |
| A6250 |
Skin seal protect moisturizr |
10,537 |
10,353 |
$64K |
| A4322 |
Irrigation syringe |
4,022 |
3,368 |
$63K |
| A5061 |
Pouch drainable w barrier at |
1,150 |
1,106 |
$63K |
| B4100 |
Food thickener oral |
873 |
836 |
$62K |
| A4353 |
Intermittent urinary cath |
87 |
75 |
$62K |
| A4407 |
Ext wear ost skn barr <=4sq" |
512 |
476 |
$60K |
| A4362 |
Solid skin barrier |
1,635 |
1,609 |
$57K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
1,029 |
987 |
$53K |
| T4533 |
Youth size brief/diaper |
599 |
582 |
$46K |
| A4425 |
Ost pch drain for barrier fl |
1,159 |
1,110 |
$44K |
| A4253 |
Blood glucose/reagent strips |
2,218 |
1,518 |
$39K |
| A4927 |
Non-sterile gloves |
6,393 |
6,234 |
$39K |
| E0776 |
Iv pole |
441 |
434 |
$35K |
| B4036 |
Enteral feed sup kit grav by |
251 |
242 |
$34K |
| A4406 |
Pectin based ostomy paste |
2,289 |
2,236 |
$33K |
| A4456 |
Adhesive remover, wipes |
3,861 |
3,739 |
$32K |
| K0553 |
Ther cgm supply allowance |
188 |
188 |
$32K |
| A5120 |
Skin barrier, wipe or swab |
3,717 |
3,618 |
$31K |
| A4357 |
Bedside drainage bag |
2,665 |
2,567 |
$27K |
| A4371 |
Skin barrier powder per oz |
2,540 |
2,506 |
$22K |
| A4338 |
Indwelling catheter latex |
1,201 |
1,128 |
$21K |
| A5056 |
1 pc ost pouch w filter |
351 |
344 |
$19K |
| A6402 |
Sterile gauze <= 16 sq in |
2,172 |
2,052 |
$18K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
299 |
286 |
$18K |
| A6257 |
Transparent film <= 16 sq in |
1,230 |
1,124 |
$18K |
| A4452 |
Waterproof tape |
1,312 |
1,070 |
$14K |
| A4402 |
Lubricant per ounce |
2,590 |
2,535 |
$12K |
| A4310 |
Insert tray w/o bag/cath |
1,073 |
1,008 |
$11K |
| A5063 |
Drain ostomy pouch w/flange |
327 |
309 |
$11K |
| A4358 |
Urinary leg or abdomen bag |
1,208 |
1,177 |
$10K |
| A4424 |
Ost pch drain w bar & filter |
183 |
181 |
$9K |
| A4349 |
Disposable male external cat |
332 |
306 |
$9K |
| B4103 |
Ef ped fluid and electrolyte |
120 |
116 |
$9K |
| A4432 |
Os pch urine w bar/fange/tap |
236 |
222 |
$8K |
| T1999 |
Noc retail items andsupplies |
187 |
179 |
$8K |
| A4259 |
Lancets per box |
1,198 |
1,183 |
$6K |
| B4082 |
Enteral ng tubing w/o stylet |
145 |
136 |
$6K |
| A4450 |
Non-waterproof tape |
1,678 |
1,430 |
$5K |
| A4216 |
Sterile water/saline, 10 ml |
262 |
254 |
$4K |
| A4344 |
Cath indw foley 2 way silicn |
40 |
37 |
$3K |
| A6216 |
Non-sterile gauze<=16 sq in |
500 |
488 |
$3K |
| A4394 |
Ostomy pouch liq deodorant |
210 |
204 |
$3K |
| E2103 |
Non-adju cgm receiver/mon |
12 |
12 |
$3K |
| A4369 |
Skin barrier liquid per oz |
241 |
235 |
$2K |
| K0554 |
Ther cgm receiver/monitor |
12 |
12 |
$2K |
| A4245 |
Alcohol wipes per box |
631 |
628 |
$967.51 |
| A6446 |
Conform band s w>=3" <5"/yd |
30 |
27 |
$867.73 |
| B4081 |
Enteral ng tubing w/ stylet |
12 |
12 |
$501.33 |
| A4367 |
Ostomy belt |
94 |
93 |
$493.90 |
| A4258 |
Lancet device each |
73 |
73 |
$76.30 |
| S9999 |
Sales tax |
42 |
42 |
$0.00 |