| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Large disposable underpad |
268,801 |
255,026 |
$16.19M |
| T4527 |
Adult size pull-on lg |
79,422 |
76,450 |
$8.25M |
| T4526 |
Adult size pull-on med |
71,144 |
68,187 |
$7.48M |
| T4535 |
Disposable liner/shield/pad |
171,422 |
164,131 |
$7.16M |
| T4528 |
Adult size pull-on xl |
49,819 |
47,932 |
$6.35M |
| B4035 |
Enteral feed supp pump per d |
23,636 |
20,589 |
$5.85M |
| B4161 |
Ef ped hydrolyzed/amino acid |
7,816 |
6,828 |
$5.20M |
| A4353 |
Intermittent urinary cath |
6,038 |
5,326 |
$4.68M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
17,603 |
15,204 |
$4.32M |
| T4544 |
Adlt disp und/pull on abv xl |
20,972 |
20,023 |
$4.02M |
| A4927 |
Non-sterile gloves |
200,826 |
189,933 |
$2.45M |
| B4150 |
Ef complet w/intact nutrient |
20,179 |
16,236 |
$2.44M |
| T4522 |
Adult size brief/diaper med |
28,236 |
26,472 |
$2.37M |
| T4524 |
Adult size brief/diaper xl |
19,665 |
18,706 |
$2.31M |
| T4523 |
Adult size brief/diaper lg |
23,112 |
21,814 |
$2.05M |
| T4525 |
Adult size pull-on sm |
23,524 |
22,108 |
$2.02M |
| B4152 |
Ef calorie dense>/=1.5kcal |
12,509 |
10,340 |
$2.01M |
| T4530 |
Ped size brief/diaper lg |
17,550 |
16,061 |
$1.70M |
| T4534 |
Youth size pull-on |
19,483 |
18,024 |
$1.44M |
| B4149 |
Ef blenderized foods |
3,567 |
3,001 |
$1.14M |
| B4154 |
Ef spec metabolic noninherit |
4,272 |
3,467 |
$1.03M |
| A4351 |
Straight tip urine catheter |
6,802 |
6,082 |
$981K |
| T4543 |
Adult disp brief/diap abv xl |
4,180 |
3,989 |
$833K |
| A6197 |
Alginate drsg >16 <=48 sq in |
2,737 |
2,453 |
$814K |
| B4088 |
Gastro/jejuno tube, low-pro |
6,807 |
6,060 |
$713K |
| B9002 |
Enter nutr inf pump any type |
1,429 |
1,264 |
$567K |
| B4153 |
Ef hydrolyzed/amino acids |
789 |
703 |
$565K |
| A4385 |
Ost skn barrier sld ext wear |
7,108 |
6,584 |
$489K |
| B4034 |
Enter feed supkit syr by day |
4,135 |
3,593 |
$482K |
| T4521 |
Adult size brief/diaper sm |
5,978 |
5,660 |
$436K |
| T4532 |
Ped size pull-on lg |
3,761 |
3,459 |
$277K |
| A6212 |
Foam drg <=16 sq in w/border |
3,116 |
2,757 |
$267K |
| B4036 |
Enteral feed sup kit grav by |
1,762 |
1,545 |
$257K |
| A4409 |
Ost skn barr convex <=4 sq i |
5,060 |
4,692 |
$251K |
| A4425 |
Ost pch drain for barrier fl |
3,818 |
3,589 |
$193K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
1,006 |
907 |
$175K |
| A6446 |
Conform band s w>=3" <5"/yd |
3,980 |
3,573 |
$173K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
2,072 |
1,843 |
$155K |
| B9998 |
Enteral supp not otherwise c |
3,215 |
2,676 |
$151K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
3,168 |
2,715 |
$147K |
| A6402 |
Sterile gauze <= 16 sq in |
10,179 |
9,052 |
$146K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
1,865 |
1,691 |
$127K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
4,402 |
3,931 |
$122K |
| A6211 |
Foam drg > 48 sq in w/o brdr |
239 |
206 |
$120K |
| A4349 |
Disposable male external cat |
3,558 |
3,171 |
$116K |
| A4452 |
Waterproof tape |
5,026 |
4,503 |
$106K |
| A5056 |
1 pc ost pouch w filter |
1,376 |
1,252 |
$104K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
1,565 |
1,371 |
$97K |
| A4357 |
Bedside drainage bag |
8,225 |
7,466 |
$96K |
| A4362 |
Solid skin barrier |
2,871 |
2,646 |
$93K |
| A5057 |
1 pc ost pou w built-in conv |
608 |
563 |
$89K |
| A4424 |
Ost pch drain w bar & filter |
1,182 |
1,097 |
$85K |
| A4407 |
Ext wear ost skn barr <=4sq" |
1,235 |
1,150 |
$84K |
| A5063 |
Drain ostomy pouch w/flange |
2,581 |
2,341 |
$83K |
| A5061 |
Pouch drainable w barrier at |
1,027 |
930 |
$61K |
| A4456 |
Adhesive remover, wipes |
7,537 |
7,012 |
$60K |
| T4533 |
Youth size brief/diaper |
853 |
812 |
$59K |
| A4388 |
Drainable pch w ex wear barr |
1,724 |
1,609 |
$55K |
| A5120 |
Skin barrier, wipe or swab |
7,398 |
6,933 |
$53K |
| A4406 |
Pectin based ostomy paste |
3,812 |
3,532 |
$53K |
| A4358 |
Urinary leg or abdomen bag |
5,510 |
4,968 |
$47K |
| A6266 |
Impreg gauze no h20/sal/yard |
243 |
227 |
$45K |
| A4216 |
Sterile water/saline, 10 ml |
3,060 |
2,763 |
$40K |
| E0776 |
Iv pole |
684 |
611 |
$39K |
| A4432 |
Os pch urine w bar/fange/tap |
796 |
739 |
$36K |
| A6257 |
Transparent film <= 16 sq in |
3,068 |
2,603 |
$34K |
| A4402 |
Lubricant per ounce |
7,250 |
6,490 |
$31K |
| B4155 |
Ef incomplete/modular |
634 |
532 |
$27K |
| A4450 |
Non-waterproof tape |
4,477 |
3,981 |
$25K |
| A4338 |
Indwelling catheter latex |
2,841 |
2,503 |
$21K |
| A4371 |
Skin barrier powder per oz |
5,190 |
4,879 |
$20K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
349 |
325 |
$17K |
| B4082 |
Enteral ng tubing w/o stylet |
1,474 |
1,272 |
$14K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
391 |
372 |
$14K |
| A4310 |
Insert tray w/o bag/cath |
2,410 |
2,143 |
$13K |
| A4394 |
Ostomy pouch liq deodorant |
1,603 |
1,516 |
$12K |
| B4158 |
Ef ped complete intact nut |
122 |
108 |
$11K |
| A6258 |
Transparent film >16<=48 in |
214 |
195 |
$8K |
| A4367 |
Ostomy belt |
1,504 |
1,409 |
$7K |
| A4322 |
Irrigation syringe |
748 |
635 |
$6K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
140 |
130 |
$5K |
| A4333 |
Urinary cath anchor device |
465 |
448 |
$5K |
| A6449 |
Lt compres band >=3" <5"/yd |
288 |
273 |
$4K |
| A4657 |
Syringe w/wo needle |
1,990 |
1,769 |
$3K |
| A4390 |
Drainable pch ex wear convex |
26 |
24 |
$2K |
| A4369 |
Skin barrier liquid per oz |
438 |
424 |
$2K |
| A6219 |
Gauze <= 16 sq in w/border |
15 |
14 |
$840.86 |
| A6216 |
Non-sterile gauze<=16 sq in |
205 |
168 |
$672.87 |
| B4081 |
Enteral ng tubing w/ stylet |
38 |
24 |
$443.78 |
| A4311 |
Catheter w/o bag 2-way latex |
40 |
36 |
$399.34 |
| A6260 |
Wound cleanser any type/size |
66 |
53 |
$157.75 |
| A6450 |
Lt compres band >=5"/yd |
28 |
28 |
$127.32 |