| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4160 |
Ef ped caloric dense>/=0.7kc |
3,696 |
2,258 |
$1.58M |
| T4534 |
Youth size pull-on |
5,786 |
4,522 |
$878K |
| B4154 |
Ef spec metabolic noninherit |
1,923 |
1,203 |
$612K |
| B4035 |
Enteral feed supp pump per d |
3,119 |
2,048 |
$581K |
| T4522 |
Adult size brief/diaper med |
3,527 |
2,649 |
$415K |
| A4554 |
Disposable underpads |
6,831 |
5,883 |
$410K |
| B4149 |
Ef blenderized foods |
1,232 |
629 |
$341K |
| B4161 |
Ef ped hydrolyzed/amino acid |
428 |
217 |
$242K |
| B4150 |
Ef complet w/intact nutrient |
2,208 |
1,317 |
$231K |
| A4927 |
Non-sterile gloves |
7,482 |
6,202 |
$187K |
| T4526 |
Adult size pull-on med |
1,335 |
1,042 |
$159K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,000 |
550 |
$123K |
| A6250 |
Skin seal protect moisturizr |
5,164 |
4,327 |
$119K |
| T4535 |
Disposable liner/shield/pad |
2,938 |
2,396 |
$112K |
| B4155 |
Ef incomplete/modular |
515 |
268 |
$105K |
| A4553 |
Nondisp underpads, all sizes |
386 |
350 |
$86K |
| B4034 |
Enter feed supkit syr by day |
1,085 |
690 |
$72K |
| T4523 |
Adult size brief/diaper lg |
734 |
484 |
$69K |
| T4533 |
Youth size brief/diaper |
709 |
519 |
$53K |
| T4521 |
Adult size brief/diaper sm |
642 |
453 |
$51K |
| T4530 |
Ped size brief/diaper lg |
687 |
516 |
$42K |
| B4087 |
Gastro/jejuno tube, std |
596 |
419 |
$35K |
| B9998 |
Enteral supp not otherwise c |
856 |
587 |
$35K |
| T4532 |
Ped size pull-on lg |
382 |
287 |
$31K |
| A6402 |
Sterile gauze <= 16 sq in |
1,923 |
1,439 |
$29K |
| T4527 |
Adult size pull-on lg |
108 |
91 |
$17K |
| A9286 |
Any hygienic item, device |
557 |
534 |
$16K |
| B9002 |
Enter nutr inf pump any type |
77 |
54 |
$7K |
| T4529 |
Ped size brief/diaper sm/med |
133 |
103 |
$7K |
| B4102 |
Ef adult fluids and electro |
106 |
61 |
$6K |
| B4153 |
Ef hydrolyzed/amino acids |
21 |
12 |
$5K |
| B4088 |
Gastro/jejuno tube, low-pro |
322 |
219 |
$4K |
| A4209 |
5+ cc sterile syringe&needle |
595 |
405 |
$2K |
| T4528 |
Adult size pull-on xl |
13 |
13 |
$2K |
| A9901 |
Delivery/set up/dispensing |
205 |
86 |
$2K |
| A4322 |
Irrigation syringe |
68 |
43 |
$2K |
| A4338 |
Indwelling catheter latex |
52 |
26 |
$1K |
| A4245 |
Alcohol wipes per box |
92 |
68 |
$631.00 |
| A5131 |
Appliance cleaner |
65 |
52 |
$425.29 |
| T5999 |
Supply, nos |
133 |
112 |
$379.41 |
| A4450 |
Non-waterproof tape |
65 |
44 |
$86.88 |
| A4244 |
Alcohol or peroxide per pint |
182 |
140 |
$75.27 |
| A4649 |
Surgical supplies |
47 |
41 |
$0.00 |