| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Large disposable underpad |
58,704 |
57,640 |
$1.82M |
| T4534 |
Youth size pull-on |
19,194 |
18,628 |
$1.61M |
| T4535 |
Disposable liner/shield/pad |
39,414 |
36,321 |
$1.32M |
| B4035 |
Enteral feed supp pump per d |
10,026 |
9,053 |
$1.29M |
| B9998 |
Enteral supp not otherwise c |
13,632 |
11,862 |
$1.03M |
| T4522 |
Adult size brief/diaper med |
15,430 |
14,944 |
$963K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
11,033 |
8,493 |
$941K |
| A4520 |
Incontinence garment anytype |
11,999 |
10,719 |
$938K |
| B4088 |
Gastro/jejuno tube, low-pro |
6,652 |
6,431 |
$887K |
| T4523 |
Adult size brief/diaper lg |
10,764 |
10,515 |
$807K |
| B4161 |
Ef ped hydrolyzed/amino acid |
3,554 |
3,206 |
$755K |
| T4527 |
Adult size pull-on lg |
12,667 |
12,411 |
$654K |
| T4526 |
Adult size pull-on med |
15,969 |
15,540 |
$642K |
| T4530 |
Ped size brief/diaper lg |
7,855 |
7,583 |
$468K |
| T4528 |
Adult size pull-on xl |
7,806 |
7,591 |
$452K |
| T5999 |
Supply, nos |
3,808 |
3,230 |
$449K |
| A4322 |
Irrigation syringe |
23,459 |
13,428 |
$317K |
| T4521 |
Adult size brief/diaper sm |
4,431 |
4,197 |
$237K |
| T4524 |
Adult size brief/diaper xl |
3,728 |
3,586 |
$232K |
| T4532 |
Ped size pull-on lg |
2,964 |
2,915 |
$179K |
| S9433 |
Medical food oral 100% nutr |
436 |
365 |
$168K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
2,002 |
1,888 |
$141K |
| T4525 |
Adult size pull-on sm |
3,548 |
3,368 |
$117K |
| T4537 |
Reusable underpad bed size |
3,559 |
3,513 |
$103K |
| A4483 |
Moisture exchanger |
253 |
235 |
$80K |
| A4927 |
Non-sterile gloves |
5,879 |
5,576 |
$70K |
| B4150 |
Ef complet w/intact nutrient |
883 |
697 |
$68K |
| S9999 |
Sales tax |
10,160 |
7,265 |
$63K |
| A7520 |
Trach/laryn tube non-cuffed |
552 |
537 |
$62K |
| B4036 |
Enteral feed sup kit grav by |
816 |
790 |
$58K |
| A6250 |
Skin seal protect moisturizr |
7,065 |
7,010 |
$53K |
| A4335 |
Incontinence supply |
8,504 |
8,414 |
$53K |
| A6402 |
Sterile gauze <= 16 sq in |
8,358 |
7,857 |
$50K |
| A7526 |
Tracheostomy tube collar |
542 |
502 |
$43K |
| B4152 |
Ef calorie dense>/=1.5kcal |
316 |
239 |
$43K |
| B4155 |
Ef incomplete/modular |
175 |
142 |
$20K |
| A6212 |
Foam drg <=16 sq in w/border |
160 |
136 |
$15K |
| A7000 |
Disposable canister for pump |
477 |
474 |
$10K |
| A4624 |
Tracheal suction tube |
138 |
125 |
$9K |
| A4623 |
Tracheostomy inner cannula |
53 |
48 |
$7K |
| A4351 |
Straight tip urine catheter |
40 |
38 |
$5K |
| A6257 |
Transparent film <= 16 sq in |
381 |
325 |
$5K |
| A4385 |
Ost skn barrier sld ext wear |
51 |
49 |
$5K |
| A4628 |
Oropharyngeal suction cath |
445 |
371 |
$4K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
75 |
75 |
$3K |
| A4657 |
Syringe w/wo needle |
773 |
593 |
$3K |
| A7002 |
Tubing used w suction pump |
174 |
167 |
$966.88 |
| E0776 |
Iv pole |
12 |
12 |
$834.04 |
| A4357 |
Bedside drainage bag |
32 |
25 |
$709.71 |
| T4536 |
Reusable pull-on any size |
38 |
38 |
$390.32 |
| A4456 |
Adhesive remover, wipes |
51 |
51 |
$356.03 |
| A4369 |
Skin barrier liquid per oz |
24 |
24 |
$89.57 |
| A5120 |
Skin barrier, wipe or swab |
25 |
24 |
$49.00 |