| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Large disposable underpad |
4,647 |
4,625 |
$460K |
| T4535 |
Disposable liner/shield/pad |
2,291 |
2,273 |
$256K |
| A4351 |
Straight tip urine catheter |
393 |
393 |
$252K |
| T4534 |
Youth size pull-on |
909 |
906 |
$208K |
| T4527 |
Adult size pull-on lg |
966 |
964 |
$180K |
| T4526 |
Adult size pull-on med |
1,039 |
1,035 |
$143K |
| T4523 |
Adult size brief/diaper lg |
758 |
756 |
$142K |
| A4335 |
Incontinence supply |
3,759 |
3,683 |
$141K |
| T4528 |
Adult size pull-on xl |
874 |
870 |
$129K |
| T4522 |
Adult size brief/diaper med |
545 |
541 |
$94K |
| A6402 |
Sterile gauze <= 16 sq in |
742 |
740 |
$67K |
| A6216 |
Non-sterile gauze<=16 sq in |
1,209 |
1,201 |
$61K |
| A6446 |
Conform band s w>=3" <5"/yd |
507 |
506 |
$50K |
| A6250 |
Skin seal protect moisturizr |
1,862 |
1,851 |
$47K |
| A4452 |
Waterproof tape |
877 |
874 |
$40K |
| T4530 |
Ped size brief/diaper lg |
356 |
356 |
$38K |
| K0553 |
Ther cgm supply allowance |
198 |
195 |
$38K |
| T4525 |
Adult size pull-on sm |
291 |
291 |
$36K |
| A4927 |
Non-sterile gloves |
1,997 |
1,989 |
$35K |
| A6197 |
Alginate drsg >16 <=48 sq in |
74 |
74 |
$31K |
| T4524 |
Adult size brief/diaper xl |
286 |
285 |
$28K |
| A6454 |
Self-adher band w>=3" <5"/yd |
224 |
224 |
$24K |
| A6456 |
Zinc paste band w >=3"<5"/yd |
118 |
117 |
$23K |
| A6545 |
Grad com non-elastic bk surg |
88 |
87 |
$21K |
| L3908 |
Who cock-up nonmolde pre ots |
306 |
302 |
$20K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
381 |
380 |
$18K |
| A6196 |
Alginate dressing <=16 sq in |
80 |
80 |
$13K |
| L3000 |
Ft insert ucb berkeley shell |
29 |
29 |
$13K |
| A4217 |
Sterile water/saline, 500 ml |
943 |
941 |
$10K |
| A6212 |
Foam drg <=16 sq in w/border |
25 |
25 |
$9K |
| E0730 |
Tens four lead |
38 |
38 |
$9K |
| E0144 |
Enclosed walker w rear seat |
33 |
33 |
$8K |
| E0603 |
Electric breast pump |
96 |
96 |
$7K |
| L1833 |
Ko adj jnt pos r sup pre ots |
12 |
12 |
$7K |
| A6260 |
Wound cleanser any type/size |
464 |
462 |
$6K |
| A5120 |
Skin barrier, wipe or swab |
104 |
104 |
$5K |
| A6449 |
Lt compres band >=3" <5"/yd |
132 |
132 |
$4K |
| L4361 |
Pneuma/vac walk boot pre ots |
14 |
14 |
$3K |
| K0554 |
Ther cgm receiver/monitor |
14 |
14 |
$3K |
| T4537 |
Reusable underpad bed size |
45 |
44 |
$3K |
| A4595 |
Tens suppl 2 lead per month |
27 |
27 |
$2K |
| A4248 |
Chlorhexidine antisept |
50 |
50 |
$2K |
| L2810 |
Knee control condylar pad |
13 |
13 |
$2K |
| L2820 |
Soft interface below knee se |
12 |
12 |
$1K |
| E0240 |
Bath/shower chair |
13 |
13 |
$1K |
| E0114 |
Crutch underarm pair no wood |
27 |
27 |
$1K |
| E0143 |
Walker folding wheeled w/o s |
13 |
13 |
$769.13 |
| B4160 |
Ef ped caloric dense>/=0.7kc |
16 |
12 |
$453.60 |
| A6443 |
Conform band n/s w>=3"<5"/yd |
12 |
12 |
$396.20 |