| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
135,160 |
129,457 |
$6.80M |
| T4527 |
Adult size pull-on lg |
33,663 |
32,164 |
$3.90M |
| T4526 |
Adult size pull-on med |
37,236 |
35,579 |
$3.84M |
| T4522 |
Adult size brief/diaper med |
26,422 |
25,098 |
$3.01M |
| T4528 |
Adult size pull-on xl |
23,720 |
22,699 |
$2.77M |
| B4149 |
Ef blenderized foods |
4,580 |
4,197 |
$2.13M |
| T4525 |
Adult size pull-on sm |
18,511 |
17,643 |
$2.04M |
| B4035 |
Enteral feed supp pump per d |
8,543 |
7,582 |
$1.97M |
| T4523 |
Adult size brief/diaper lg |
15,203 |
14,458 |
$1.85M |
| A4928 |
Surgical mask |
11,435 |
10,916 |
$1.79M |
| B4161 |
Ef ped hydrolyzed/amino acid |
3,226 |
2,932 |
$1.69M |
| A4927 |
Non-sterile gloves |
53,806 |
50,724 |
$1.65M |
| T4534 |
Youth size pull-on |
13,702 |
12,965 |
$1.64M |
| T4544 |
Adlt disp und/pull on abv xl |
8,676 |
8,332 |
$1.46M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
8,272 |
7,804 |
$1.22M |
| B4150 |
Ef complet w/intact nutrient |
9,843 |
8,394 |
$1.11M |
| T4521 |
Adult size brief/diaper sm |
8,740 |
8,320 |
$976K |
| T4533 |
Youth size brief/diaper |
8,963 |
8,379 |
$924K |
| B4153 |
Ef hydrolyzed/amino acids |
1,458 |
1,281 |
$897K |
| T4524 |
Adult size brief/diaper xl |
6,415 |
6,097 |
$747K |
| B4034 |
Enter feed supkit syr by day |
5,334 |
4,510 |
$608K |
| B4152 |
Ef calorie dense>/=1.5kcal |
4,227 |
3,253 |
$605K |
| B4154 |
Ef spec metabolic noninherit |
2,861 |
2,572 |
$603K |
| T4532 |
Ped size pull-on lg |
4,749 |
4,453 |
$569K |
| B4088 |
Gastro/jejuno tube, low-pro |
5,173 |
4,427 |
$487K |
| T4530 |
Ped size brief/diaper lg |
4,882 |
4,693 |
$442K |
| B9998 |
Enteral supp not otherwise c |
26,457 |
11,433 |
$356K |
| T4535 |
Disposable liner/shield/pad |
9,191 |
8,564 |
$349K |
| A4351 |
Straight tip urine catheter |
2,083 |
1,593 |
$259K |
| T4543 |
Adult disp brief/diap abv xl |
1,470 |
1,393 |
$221K |
| B4155 |
Ef incomplete/modular |
1,509 |
1,380 |
$211K |
| B4103 |
Ef ped fluid and electrolyte |
1,232 |
1,185 |
$113K |
| B9002 |
Enter nutr inf pump any type |
69 |
60 |
$59K |
| B4100 |
Food thickener oral |
737 |
614 |
$41K |
| A4213 |
20+ cc syringe only |
1,821 |
1,644 |
$33K |
| A4385 |
Ost skn barrier sld ext wear |
499 |
331 |
$23K |
| A4357 |
Bedside drainage bag |
1,321 |
866 |
$12K |
| A4409 |
Ost skn barr convex <=4 sq i |
148 |
108 |
$10K |
| E1399 |
Durable medical equipment mi |
117 |
111 |
$9K |
| B4036 |
Enteral feed sup kit grav by |
71 |
62 |
$9K |
| A4406 |
Pectin based ostomy paste |
618 |
458 |
$8K |
| A9999 |
Dme supply or accessory, nos |
33 |
24 |
$5K |
| A4402 |
Lubricant per ounce |
1,125 |
903 |
$4K |
| A5120 |
Skin barrier, wipe or swab |
506 |
325 |
$2K |
| A4456 |
Adhesive remover, wipes |
167 |
129 |
$1K |
| A5063 |
Drain ostomy pouch w/flange |
61 |
38 |
$1K |
| A4217 |
Sterile water/saline, 500 ml |
42 |
24 |
$900.07 |
| A4371 |
Skin barrier powder per oz |
113 |
81 |
$746.05 |
| A4394 |
Ostomy pouch liq deodorant |
32 |
24 |
$536.60 |
| A4358 |
Urinary leg or abdomen bag |
38 |
25 |
$364.08 |
| A4657 |
Syringe w/wo needle |
18 |
15 |
$0.00 |