| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4649 |
Surgical supplies |
792 |
587 |
$810K |
| T4527 |
Adult size pull-on lg |
4,747 |
4,402 |
$531K |
| T4528 |
Adult size pull-on xl |
4,359 |
3,930 |
$512K |
| A4927 |
Non-sterile gloves |
26,942 |
24,605 |
$413K |
| T4541 |
Large disposable underpad |
11,250 |
10,009 |
$390K |
| E1399 |
Durable medical equipment mi |
807 |
472 |
$363K |
| T4544 |
Adlt disp und/pull on abv xl |
1,395 |
1,259 |
$349K |
| B4100 |
Food thickener oral |
1,139 |
764 |
$329K |
| T4526 |
Adult size pull-on med |
2,473 |
2,188 |
$237K |
| T4523 |
Adult size brief/diaper lg |
1,580 |
1,450 |
$168K |
| T4522 |
Adult size brief/diaper med |
1,671 |
1,550 |
$167K |
| T4535 |
Disposable liner/shield/pad |
3,707 |
3,217 |
$146K |
| T4524 |
Adult size brief/diaper xl |
963 |
903 |
$104K |
| T4537 |
Reusable underpad bed size |
5,399 |
4,894 |
$95K |
| A9286 |
Any hygienic item, device |
1,854 |
728 |
$75K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
769 |
679 |
$28K |
| A4385 |
Ost skn barrier sld ext wear |
1,598 |
1,297 |
$28K |
| A4362 |
Solid skin barrier |
1,241 |
1,008 |
$23K |
| A6446 |
Conform band s w>=3" <5"/yd |
1,289 |
1,082 |
$22K |
| A6402 |
Sterile gauze <= 16 sq in |
1,579 |
1,397 |
$21K |
| T4543 |
Adult disp brief/diap abv xl |
50 |
49 |
$15K |
| A4357 |
Bedside drainage bag |
1,950 |
1,674 |
$12K |
| A6196 |
Alginate dressing <=16 sq in |
136 |
124 |
$10K |
| A4452 |
Waterproof tape |
597 |
470 |
$8K |
| A6212 |
Foam drg <=16 sq in w/border |
174 |
138 |
$8K |
| T4525 |
Adult size pull-on sm |
70 |
61 |
$6K |
| A4217 |
Sterile water/saline, 500 ml |
1,799 |
1,613 |
$6K |
| A4450 |
Non-waterproof tape |
1,198 |
1,037 |
$5K |
| A7048 |
Vacuum drain bottle/tube kit |
24 |
12 |
$5K |
| A6216 |
Non-sterile gauze<=16 sq in |
1,003 |
874 |
$5K |
| A5120 |
Skin barrier, wipe or swab |
1,913 |
1,514 |
$4K |
| A4310 |
Insert tray w/o bag/cath |
888 |
792 |
$3K |
| A5063 |
Drain ostomy pouch w/flange |
246 |
209 |
$2K |
| A4338 |
Indwelling catheter latex |
467 |
418 |
$2K |
| A4406 |
Pectin based ostomy paste |
517 |
424 |
$2K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
67 |
52 |
$2K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
93 |
87 |
$1K |
| A4389 |
Drainable pch w st wear barr |
25 |
25 |
$1K |
| A6219 |
Gauze <= 16 sq in w/border |
38 |
38 |
$746.48 |
| A6530 |
Compression stocking bk18-30 |
18 |
12 |
$476.08 |
| A4456 |
Adhesive remover, wipes |
122 |
90 |
$227.96 |
| A6449 |
Lt compres band >=3" <5"/yd |
15 |
12 |
$64.83 |
| A4371 |
Skin barrier powder per oz |
14 |
13 |
$31.14 |