| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6250 |
Skin seal protect moisturizr |
32,342 |
31,154 |
$8.53M |
| A4554 |
Disposable underpads |
44,381 |
42,737 |
$3.33M |
| T4523 |
Adult size brief/diaper lg |
21,071 |
20,455 |
$3.08M |
| T4524 |
Adult size brief/diaper xl |
12,066 |
11,728 |
$1.90M |
| T4522 |
Adult size brief/diaper med |
16,217 |
15,702 |
$1.70M |
| T4535 |
Disposable liner/shield/pad |
16,628 |
16,244 |
$1.42M |
| A6260 |
Wound cleanser any type/size |
24,670 |
24,262 |
$1.31M |
| A4927 |
Non-sterile gloves |
50,127 |
48,527 |
$1.21M |
| A4670 |
Automatic bp monitor, dial |
10,551 |
10,196 |
$1.00M |
| A6530 |
Compression stocking bk18-30 |
6,981 |
6,714 |
$957K |
| T4543 |
Adult disp brief/diap abv xl |
3,080 |
2,982 |
$655K |
| A4351 |
Straight tip urine catheter |
3,214 |
3,085 |
$499K |
| T4529 |
Ped size brief/diaper sm/med |
3,994 |
3,887 |
$443K |
| E0570 |
Nebulizer with compression |
4,983 |
4,787 |
$423K |
| A4239 |
Non-adju cgm supply allow |
2,842 |
2,777 |
$419K |
| T4530 |
Ped size brief/diaper lg |
3,924 |
3,761 |
$405K |
| A5120 |
Skin barrier, wipe or swab |
17,245 |
16,907 |
$404K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
1,688 |
1,489 |
$351K |
| A6533 |
Gc stocking thighlngth 18-30 |
3,342 |
3,206 |
$306K |
| S5199 |
Personal care item nos each |
9,365 |
9,189 |
$291K |
| T4521 |
Adult size brief/diaper sm |
2,756 |
2,684 |
$283K |
| E0245 |
Tub stool or bench |
2,967 |
2,832 |
$244K |
| A6212 |
Foam drg <=16 sq in w/border |
1,138 |
1,086 |
$232K |
| A6402 |
Sterile gauze <= 16 sq in |
8,550 |
8,069 |
$200K |
| E0246 |
Transfer tub rail attachment |
540 |
528 |
$183K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
2,437 |
2,331 |
$166K |
| K0553 |
Ther cgm supply allowance |
1,529 |
1,432 |
$165K |
| A6446 |
Conform band s w>=3" <5"/yd |
3,372 |
3,241 |
$146K |
| A4385 |
Ost skn barrier sld ext wear |
1,754 |
1,660 |
$127K |
| E0260 |
Hosp bed semi-electr w/ matt |
2,506 |
2,408 |
$122K |
| E0603 |
Electric breast pump |
1,059 |
1,019 |
$120K |
| A4928 |
Surgical mask |
6,633 |
6,530 |
$116K |
| E0143 |
Walker folding wheeled w/o s |
2,451 |
2,343 |
$104K |
| A4450 |
Non-waterproof tape |
4,555 |
4,310 |
$94K |
| A6539 |
Gc stocking waistlngth 18-30 |
481 |
470 |
$91K |
| K0001 |
Standard wheelchair |
4,997 |
4,688 |
$90K |
| A4217 |
Sterile water/saline, 500 ml |
3,749 |
3,588 |
$89K |
| A5063 |
Drain ostomy pouch w/flange |
2,250 |
2,156 |
$87K |
| L3908 |
Who cock-up nonmolde pre ots |
1,734 |
1,264 |
$79K |
| A6449 |
Lt compres band >=3" <5"/yd |
1,971 |
1,851 |
$79K |
| A6197 |
Alginate drsg >16 <=48 sq in |
198 |
186 |
$76K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
213 |
202 |
$72K |
| A6196 |
Alginate dressing <=16 sq in |
395 |
380 |
$71K |
| L8000 |
Mastectomy bra |
1,352 |
1,289 |
$69K |
| E0243 |
Toilet rail |
1,358 |
1,019 |
$67K |
| A5061 |
Pouch drainable w barrier at |
1,349 |
1,263 |
$64K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
1,039 |
983 |
$60K |
| A6214 |
Foam drg > 48 sq in w/border |
290 |
277 |
$54K |
| A4452 |
Waterproof tape |
1,140 |
1,096 |
$45K |
| L1812 |
Ko elastic w/joints pre ots |
526 |
420 |
$41K |
| A4349 |
Disposable male external cat |
1,196 |
1,131 |
$40K |
| E0241 |
Bath tub wall rail |
906 |
872 |
$38K |
| E0244 |
Toilet seat raised |
828 |
805 |
$33K |
| E0163 |
Commode chair with fixed arm |
614 |
586 |
$29K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
473 |
454 |
$29K |
| A5512 |
Multi den insert direct form |
393 |
228 |
$28K |
| E0149 |
Heavy duty wheeled walker |
1,202 |
1,125 |
$28K |
| E0156 |
Walker seat attachment |
2,289 |
2,183 |
$27K |
| A6258 |
Transparent film >16<=48 in |
225 |
221 |
$25K |
| A6443 |
Conform band n/s w>=3"<5"/yd |
945 |
910 |
$24K |
| K0195 |
Elevating whlchair leg rests |
2,063 |
1,943 |
$23K |
| E0630 |
Patient lift hydraulic |
669 |
629 |
$23K |
| A5500 |
Diab shoe for density insert |
395 |
227 |
$23K |
| A4357 |
Bedside drainage bag |
2,137 |
2,015 |
$20K |
| B4150 |
Ef complet w/intact nutrient |
300 |
271 |
$20K |
| A4394 |
Ostomy pouch liq deodorant |
1,492 |
1,423 |
$20K |
| E0303 |
Hosp bed hvy dty xtra wide |
137 |
133 |
$19K |
| A4245 |
Alcohol wipes per box |
2,690 |
2,486 |
$17K |
| A4358 |
Urinary leg or abdomen bag |
2,000 |
1,935 |
$15K |
| A4402 |
Lubricant per ounce |
2,425 |
2,332 |
$15K |
| A4407 |
Ext wear ost skn barr <=4sq" |
82 |
82 |
$14K |
| A4456 |
Adhesive remover, wipes |
1,369 |
1,322 |
$13K |
| K0004 |
High strength ltwt whlchr |
271 |
262 |
$12K |
| A4353 |
Intermittent urinary cath |
12 |
12 |
$12K |
| E0165 |
Commode chair with detacharm |
702 |
677 |
$10K |
| K0007 |
Extra heavy duty wheelchair |
108 |
105 |
$10K |
| A4408 |
Ext wear ost skn barr >4sq" |
52 |
52 |
$10K |
| E0100 |
Cane adjust/fixed with tip |
634 |
587 |
$10K |
| A6211 |
Foam drg > 48 sq in w/o brdr |
12 |
12 |
$8K |
| E0604 |
Hosp grade elec breast pump |
115 |
99 |
$7K |
| A7005 |
Nondisposable nebulizer set |
461 |
447 |
$7K |
| A6248 |
Hydrogel drsg gel filler |
50 |
50 |
$6K |
| L8030 |
Breast prosthes w/o adhesive |
33 |
30 |
$5K |
| L0625 |
Lo flex l1-below l5 pre ots |
126 |
125 |
$5K |
| A4409 |
Ost skn barr convex <=4 sq i |
41 |
40 |
$5K |
| A6216 |
Non-sterile gauze<=16 sq in |
449 |
428 |
$4K |
| A4344 |
Cath indw foley 2 way silicn |
85 |
84 |
$4K |
| A4931 |
Reusable oral thermometer |
375 |
370 |
$3K |
| A7015 |
Aerosol mask used w nebulize |
2,643 |
2,571 |
$3K |
| A7003 |
Nebulizer administration set |
2,005 |
1,965 |
$3K |
| A6207 |
Contact layer >16<= 48 sq in |
38 |
37 |
$3K |
| E1038 |
Transport chair pt wt<=300lb |
248 |
235 |
$3K |
| A4406 |
Pectin based ostomy paste |
79 |
77 |
$3K |
| A4246 |
Betadine/phisohex solution |
94 |
85 |
$2K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
12 |
12 |
$2K |
| E0105 |
Cane adjust/fixed quad/3 pro |
57 |
55 |
$2K |
| E0210 |
Electric heat pad standard |
81 |
73 |
$2K |
| A6531 |
Compress stking bk30-40 surg |
12 |
12 |
$2K |
| A6441 |
Pad band w>=3" <5"/yd |
150 |
148 |
$2K |
| A4371 |
Skin barrier powder per oz |
260 |
252 |
$2K |
| A5054 |
Clsd ostomy pouch w/flange |
45 |
37 |
$1K |
| E0602 |
Manual breast pump |
53 |
52 |
$1K |
| T4532 |
Ped size pull-on lg |
1,502 |
1,498 |
$1K |
| A4213 |
20+ cc syringe only |
50 |
50 |
$1K |
| B4088 |
Gastro/jejuno tube, low-pro |
19 |
14 |
$1K |
| E0261 |
Hosp bed semi-electr w/o mat |
27 |
24 |
$1K |
| L0650 |
Lso sc r ant/pos pnl pre ots |
49 |
46 |
$983.39 |
| A4415 |
Ost skn barr w/o conv >4 sqi |
12 |
12 |
$870.64 |
| T4534 |
Youth size pull-on |
164 |
146 |
$784.00 |
| A4338 |
Indwelling catheter latex |
40 |
39 |
$774.41 |
| A4364 |
Adhesive, liquid or equal |
53 |
48 |
$670.89 |
| A4663 |
Dialysis blood pressure cuff |
35 |
32 |
$510.72 |
| A4253 |
Blood glucose/reagent strips |
25 |
25 |
$366.30 |
| L3960 |
Sewho airplan desig abdu pos |
35 |
34 |
$328.99 |
| L3916 |
Who nontorsion jnts pre ots |
13 |
12 |
$97.24 |
| Q0513 |
Disp fee inhal drugs/30 days |
12 |
12 |
$4.21 |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,448 |
1,386 |
$0.01 |
| T4531 |
Ped size pull-on sm/med |
49 |
43 |
$0.00 |
| L1971 |
Afo w/ankle joint, prefab |
23 |
13 |
$0.00 |
| A4335 |
Incontinence supply |
6,156 |
6,125 |
$0.00 |