| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
14,679 |
13,694 |
$9.68M |
| B4035 |
Enteral feed supp pump per d |
22,782 |
21,806 |
$6.06M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
23,494 |
22,518 |
$5.36M |
| B9998 |
Enteral supp not otherwise c |
32,764 |
23,854 |
$2.19M |
| B4155 |
Ef incomplete/modular |
6,739 |
6,460 |
$2.16M |
| B4149 |
Ef blenderized foods |
3,749 |
3,532 |
$1.49M |
| B4153 |
Ef hydrolyzed/amino acids |
746 |
717 |
$881K |
| B4154 |
Ef spec metabolic noninherit |
1,693 |
1,562 |
$865K |
| T4534 |
Youth size pull-on |
8,454 |
7,767 |
$782K |
| B4152 |
Ef calorie dense>/=1.5kcal |
2,564 |
2,467 |
$709K |
| B4150 |
Ef complet w/intact nutrient |
2,755 |
2,664 |
$604K |
| A4554 |
Disposable underpads |
20,341 |
19,865 |
$601K |
| B4162 |
Ef ped specmetabolic inherit |
804 |
760 |
$574K |
| B9002 |
Enter nutr inf pump any type |
6,770 |
6,649 |
$512K |
| T4530 |
Ped size brief/diaper lg |
6,558 |
5,971 |
$508K |
| B4158 |
Ef ped complete intact nut |
2,819 |
2,589 |
$496K |
| B4034 |
Enter feed supkit syr by day |
2,549 |
2,466 |
$322K |
| T4532 |
Ped size pull-on lg |
2,145 |
1,995 |
$263K |
| A4351 |
Straight tip urine catheter |
1,446 |
1,120 |
$214K |
| T4522 |
Adult size brief/diaper med |
2,288 |
2,206 |
$199K |
| T4526 |
Adult size pull-on med |
2,001 |
1,960 |
$196K |
| T4527 |
Adult size pull-on lg |
1,313 |
1,272 |
$162K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
1,441 |
1,368 |
$154K |
| B4103 |
Ef ped fluid and electrolyte |
2,145 |
2,073 |
$153K |
| A4322 |
Irrigation syringe |
19,563 |
18,557 |
$151K |
| B4036 |
Enteral feed sup kit grav by |
950 |
931 |
$134K |
| A4335 |
Incontinence supply |
25,470 |
24,698 |
$122K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
2,266 |
2,103 |
$120K |
| T4523 |
Adult size brief/diaper lg |
1,250 |
1,148 |
$112K |
| T4528 |
Adult size pull-on xl |
677 |
655 |
$101K |
| A6212 |
Foam drg <=16 sq in w/border |
399 |
343 |
$82K |
| A4452 |
Waterproof tape |
9,775 |
9,414 |
$82K |
| A7000 |
Disposable canister for pump |
3,265 |
2,840 |
$78K |
| A6402 |
Sterile gauze <= 16 sq in |
15,236 |
14,769 |
$77K |
| B4104 |
Additive for enteral formula |
1,305 |
1,266 |
$74K |
| B4088 |
Gastro/jejuno tube, low-pro |
1,044 |
892 |
$71K |
| T4521 |
Adult size brief/diaper sm |
904 |
801 |
$66K |
| B4100 |
Food thickener oral |
1,476 |
1,434 |
$48K |
| B4082 |
Enteral ng tubing w/o stylet |
1,071 |
949 |
$46K |
| E0776 |
Iv pole |
5,244 |
5,192 |
$35K |
| A7002 |
Tubing used w suction pump |
3,087 |
2,970 |
$35K |
| A4927 |
Non-sterile gloves |
4,226 |
3,942 |
$32K |
| A6257 |
Transparent film <= 16 sq in |
2,282 |
1,919 |
$31K |
| T4533 |
Youth size brief/diaper |
359 |
318 |
$28K |
| T1999 |
Noc retail items andsupplies |
977 |
872 |
$27K |
| T4535 |
Disposable liner/shield/pad |
1,195 |
1,158 |
$25K |
| A4402 |
Lubricant per ounce |
3,190 |
3,100 |
$21K |
| A4628 |
Oropharyngeal suction cath |
3,203 |
2,976 |
$19K |
| B4081 |
Enteral ng tubing w/ stylet |
356 |
313 |
$16K |
| A6250 |
Skin seal protect moisturizr |
2,948 |
2,691 |
$13K |
| T4541 |
Large disposable underpad |
343 |
302 |
$10K |
| A4369 |
Skin barrier liquid per oz |
617 |
602 |
$8K |
| A4344 |
Cath indw foley 2 way silicn |
222 |
198 |
$7K |
| T4524 |
Adult size brief/diaper xl |
61 |
61 |
$7K |
| A5200 |
Percutaneous catheter anchor |
489 |
430 |
$7K |
| A4624 |
Tracheal suction tube |
69 |
50 |
$6K |
| A4253 |
Blood glucose/reagent strips |
405 |
380 |
$5K |
| A4371 |
Skin barrier powder per oz |
732 |
726 |
$4K |
| A7003 |
Nebulizer administration set |
1,356 |
1,316 |
$4K |
| A6216 |
Non-sterile gauze<=16 sq in |
549 |
543 |
$4K |
| A4213 |
20+ cc syringe only |
1,184 |
1,128 |
$3K |
| A7015 |
Aerosol mask used w nebulize |
1,715 |
1,667 |
$2K |
| A4259 |
Lancets per box |
429 |
427 |
$2K |
| T4525 |
Adult size pull-on sm |
14 |
14 |
$1K |
| A4250 |
Urine reagent strips/tablets |
147 |
144 |
$1K |
| A5120 |
Skin barrier, wipe or swab |
178 |
150 |
$1K |
| A4245 |
Alcohol wipes per box |
657 |
651 |
$1K |
| A7005 |
Nondisposable nebulizer set |
81 |
79 |
$939.31 |
| A6260 |
Wound cleanser any type/size |
69 |
68 |
$611.94 |
| A4456 |
Adhesive remover, wipes |
14 |
14 |
$144.95 |
| A4256 |
Calibrator solution/chips |
12 |
12 |
$8.12 |