| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4353 |
Intermittent urinary cath |
1,797 |
1,595 |
$878K |
| A4351 |
Straight tip urine catheter |
4,774 |
4,450 |
$499K |
| A4352 |
Coude tip urinary catheter |
838 |
799 |
$249K |
| A4409 |
Ost skn barr convex <=4 sq i |
779 |
718 |
$65K |
| T4527 |
Adult size pull-on lg |
734 |
695 |
$62K |
| T4522 |
Adult size brief/diaper med |
732 |
698 |
$60K |
| A4385 |
Ost skn barrier sld ext wear |
759 |
668 |
$58K |
| A4407 |
Ext wear ost skn barr <=4sq" |
422 |
369 |
$51K |
| T4526 |
Adult size pull-on med |
723 |
660 |
$46K |
| T4541 |
Large disposable underpad |
1,172 |
1,146 |
$45K |
| T4534 |
Youth size pull-on |
657 |
600 |
$45K |
| T4528 |
Adult size pull-on xl |
403 |
392 |
$41K |
| T4523 |
Adult size brief/diaper lg |
429 |
403 |
$40K |
| T4535 |
Disposable liner/shield/pad |
785 |
746 |
$31K |
| T4530 |
Ped size brief/diaper lg |
551 |
487 |
$29K |
| A5063 |
Drain ostomy pouch w/flange |
864 |
787 |
$26K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
478 |
443 |
$24K |
| A4554 |
Disposable underpads |
1,010 |
864 |
$24K |
| A4927 |
Non-sterile gloves |
2,259 |
1,986 |
$23K |
| A4349 |
Disposable male external cat |
812 |
690 |
$21K |
| T4524 |
Adult size brief/diaper xl |
198 |
194 |
$20K |
| A4332 |
Lube sterile packet |
1,250 |
1,195 |
$19K |
| T4525 |
Adult size pull-on sm |
285 |
267 |
$18K |
| A4425 |
Ost pch drain for barrier fl |
450 |
402 |
$16K |
| A4314 |
Cath w/drainage 2-way latex |
423 |
342 |
$15K |
| A4362 |
Solid skin barrier |
388 |
327 |
$15K |
| A4357 |
Bedside drainage bag |
1,394 |
1,248 |
$14K |
| T4521 |
Adult size brief/diaper sm |
165 |
158 |
$12K |
| A4358 |
Urinary leg or abdomen bag |
1,076 |
916 |
$10K |
| A4432 |
Os pch urine w bar/fange/tap |
288 |
246 |
$9K |
| A4406 |
Pectin based ostomy paste |
765 |
689 |
$8K |
| A4217 |
Sterile water/saline, 500 ml |
411 |
390 |
$7K |
| A4402 |
Lubricant per ounce |
1,640 |
1,571 |
$7K |
| A4520 |
Incontinence garment anytype |
700 |
679 |
$6K |
| A4399 |
Ostomy irrig cone/cath w brs |
228 |
222 |
$4K |
| A4456 |
Adhesive remover, wipes |
425 |
389 |
$4K |
| A4398 |
Ostomy irrigation bag |
222 |
217 |
$4K |
| A4320 |
Irrigation tray |
56 |
49 |
$4K |
| A5120 |
Skin barrier, wipe or swab |
1,036 |
947 |
$4K |
| A4344 |
Cath indw foley 2 way silicn |
237 |
222 |
$4K |
| A4394 |
Ostomy pouch liq deodorant |
252 |
229 |
$3K |
| A4452 |
Waterproof tape |
242 |
207 |
$3K |
| A4367 |
Ostomy belt |
349 |
325 |
$2K |
| A4371 |
Skin barrier powder per oz |
614 |
556 |
$2K |
| B4036 |
Enteral feed sup kit grav by |
107 |
104 |
$2K |
| A5061 |
Pouch drainable w barrier at |
28 |
27 |
$1K |
| A4373 |
Skin barrier with flange |
13 |
13 |
$1K |
| A4455 |
Adhesive remover per ounce |
214 |
202 |
$403.87 |
| A4419 |
Ost pch for bar w flange/flt |
13 |
12 |
$332.46 |