| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
46,852 |
42,959 |
$1.32M |
| T4526 |
Adult size pull-on med |
23,200 |
22,661 |
$1.14M |
| T4527 |
Adult size pull-on lg |
20,482 |
20,094 |
$1.00M |
| T4528 |
Adult size pull-on xl |
12,131 |
11,822 |
$723K |
| T4535 |
Disposable liner/shield/pad |
10,467 |
10,291 |
$445K |
| A4245 |
Alcohol wipes per box |
60,845 |
58,301 |
$391K |
| T4524 |
Adult size brief/diaper xl |
5,113 |
5,003 |
$337K |
| T4523 |
Adult size brief/diaper lg |
5,416 |
5,218 |
$330K |
| T4534 |
Youth size pull-on |
2,513 |
2,244 |
$324K |
| T4522 |
Adult size brief/diaper med |
4,142 |
3,880 |
$303K |
| A4927 |
Non-sterile gloves |
47,117 |
44,686 |
$299K |
| A5120 |
Skin barrier, wipe or swab |
13,899 |
11,879 |
$186K |
| T4530 |
Ped size brief/diaper lg |
1,724 |
1,545 |
$164K |
| T4525 |
Adult size pull-on sm |
2,454 |
2,359 |
$138K |
| T4543 |
Adult disp brief/diap abv xl |
1,151 |
1,119 |
$131K |
| T4544 |
Adlt disp und/pull on abv xl |
1,693 |
1,666 |
$127K |
| A4353 |
Intermittent urinary cath |
152 |
131 |
$89K |
| T4521 |
Adult size brief/diaper sm |
859 |
736 |
$84K |
| T4541 |
Large disposable underpad |
2,098 |
2,071 |
$64K |
| B4150 |
Ef complet w/intact nutrient |
605 |
587 |
$64K |
| A4351 |
Straight tip urine catheter |
197 |
165 |
$40K |
| A6250 |
Skin seal protect moisturizr |
1,916 |
1,861 |
$30K |
| A4409 |
Ost skn barr convex <=4 sq i |
338 |
260 |
$29K |
| S5199 |
Personal care item nos each |
438 |
392 |
$24K |
| A6402 |
Sterile gauze <= 16 sq in |
454 |
304 |
$22K |
| E1399 |
Durable medical equipment mi |
74 |
58 |
$17K |
| A4425 |
Ost pch drain for barrier fl |
298 |
232 |
$13K |
| A4385 |
Ost skn barrier sld ext wear |
602 |
467 |
$13K |
| A4358 |
Urinary leg or abdomen bag |
167 |
149 |
$9K |
| A4456 |
Adhesive remover, wipes |
1,377 |
1,115 |
$8K |
| A4216 |
Sterile water/saline, 10 ml |
337 |
281 |
$7K |
| A4357 |
Bedside drainage bag |
539 |
447 |
$7K |
| A4310 |
Insert tray w/o bag/cath |
77 |
67 |
$6K |
| A4362 |
Solid skin barrier |
295 |
248 |
$6K |
| B4154 |
Ef spec metabolic noninherit |
29 |
25 |
$4K |
| A4371 |
Skin barrier powder per oz |
424 |
331 |
$3K |
| A4349 |
Disposable male external cat |
38 |
37 |
$3K |
| A4394 |
Ostomy pouch liq deodorant |
481 |
368 |
$2K |
| A5061 |
Pouch drainable w barrier at |
25 |
24 |
$2K |
| T4532 |
Ped size pull-on lg |
20 |
13 |
$2K |
| A4450 |
Non-waterproof tape |
288 |
251 |
$1K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
18 |
12 |
$1K |
| A6216 |
Non-sterile gauze<=16 sq in |
17 |
12 |
$1K |
| A4406 |
Pectin based ostomy paste |
389 |
314 |
$787.93 |
| A4338 |
Indwelling catheter latex |
30 |
24 |
$533.34 |
| T4540 |
Reusable underpad chair size |
24 |
24 |
$232.00 |
| A6447 |
Conform band s w >=5"/yd |
136 |
125 |
$134.52 |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
15 |
14 |
$36.92 |
| A9901 |
Delivery/set up/dispensing |
30 |
27 |
$26.00 |