| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
5,232 |
5,177 |
$2.73M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
9,607 |
9,406 |
$1.42M |
| A4927 |
Non-sterile gloves |
45,648 |
45,354 |
$1.39M |
| T4541 |
Large disposable underpad |
27,314 |
27,187 |
$1.32M |
| T4523 |
Adult size brief/diaper lg |
10,197 |
10,166 |
$1.22M |
| B4150 |
Ef complet w/intact nutrient |
5,929 |
5,865 |
$849K |
| T4535 |
Disposable liner/shield/pad |
12,569 |
12,497 |
$775K |
| T4534 |
Youth size pull-on |
4,677 |
4,638 |
$705K |
| T4522 |
Adult size brief/diaper med |
7,441 |
7,386 |
$698K |
| T4528 |
Adult size pull-on xl |
5,030 |
5,013 |
$668K |
| T4524 |
Adult size brief/diaper xl |
4,315 |
4,300 |
$650K |
| T4527 |
Adult size pull-on lg |
5,989 |
5,970 |
$646K |
| T4526 |
Adult size pull-on med |
6,164 |
6,142 |
$612K |
| B4100 |
Food thickener oral |
5,852 |
5,785 |
$566K |
| T4543 |
Adult disp brief/diap abv xl |
1,922 |
1,912 |
$513K |
| B4152 |
Ef calorie dense>/=1.5kcal |
2,668 |
2,649 |
$399K |
| T4537 |
Reusable underpad bed size |
24,923 |
24,810 |
$395K |
| T4530 |
Ped size brief/diaper lg |
2,222 |
2,206 |
$271K |
| A4351 |
Straight tip urine catheter |
1,013 |
952 |
$174K |
| B4035 |
Enteral feed supp pump per d |
713 |
644 |
$148K |
| B4087 |
Gastro/jejuno tube, std |
607 |
591 |
$65K |
| T4532 |
Ped size pull-on lg |
367 |
360 |
$56K |
| A4349 |
Disposable male external cat |
729 |
713 |
$28K |
| A9901 |
Delivery/set up/dispensing |
6,424 |
6,423 |
$19K |
| A4353 |
Intermittent urinary cath |
43 |
38 |
$18K |
| A6250 |
Skin seal protect moisturizr |
1,495 |
1,445 |
$14K |
| B4154 |
Ef spec metabolic noninherit |
95 |
91 |
$11K |
| A4357 |
Bedside drainage bag |
2,410 |
2,371 |
$9K |
| A6402 |
Sterile gauze <= 16 sq in |
478 |
434 |
$4K |
| A4358 |
Urinary leg or abdomen bag |
1,168 |
1,144 |
$4K |
| A4217 |
Sterile water/saline, 500 ml |
227 |
219 |
$3K |
| A4314 |
Cath w/drainage 2-way latex |
280 |
276 |
$2K |
| A4450 |
Non-waterproof tape |
98 |
91 |
$771.39 |
| A4402 |
Lubricant per ounce |
61 |
61 |
$156.52 |
| A5120 |
Skin barrier, wipe or swab |
14 |
13 |
$107.12 |
| A4331 |
Extension drainage tubing |
56 |
52 |
$77.10 |