| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
50,891 |
48,650 |
$1.68M |
| T4527 |
Adult size pull-on lg |
11,109 |
10,776 |
$1.53M |
| T4534 |
Youth size pull-on |
10,974 |
10,337 |
$1.23M |
| T4526 |
Adult size pull-on med |
9,732 |
9,282 |
$1.08M |
| T4528 |
Adult size pull-on xl |
5,644 |
5,444 |
$922K |
| B4153 |
Ef hydrolyzed/amino acids |
408 |
398 |
$800K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
2,273 |
2,189 |
$655K |
| T4535 |
Disposable liner/shield/pad |
15,980 |
15,331 |
$574K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,555 |
1,428 |
$529K |
| B4035 |
Enteral feed supp pump per d |
1,616 |
1,544 |
$450K |
| T4522 |
Adult size brief/diaper med |
4,659 |
4,445 |
$437K |
| T4523 |
Adult size brief/diaper lg |
4,093 |
3,944 |
$403K |
| B9998 |
Enteral supp not otherwise c |
4,132 |
3,021 |
$359K |
| B4150 |
Ef complet w/intact nutrient |
1,289 |
1,195 |
$347K |
| A4335 |
Incontinence supply |
62,262 |
58,515 |
$319K |
| T4532 |
Ped size pull-on lg |
1,781 |
1,728 |
$270K |
| T4524 |
Adult size brief/diaper xl |
2,154 |
2,015 |
$260K |
| A4351 |
Straight tip urine catheter |
1,383 |
1,253 |
$248K |
| A4253 |
Blood glucose/reagent strips |
9,710 |
7,869 |
$248K |
| T4544 |
Adlt disp und/pull on abv xl |
1,123 |
1,021 |
$221K |
| T4525 |
Adult size pull-on sm |
1,719 |
1,614 |
$150K |
| T4530 |
Ped size brief/diaper lg |
1,382 |
1,325 |
$113K |
| B4034 |
Enter feed supkit syr by day |
1,314 |
1,278 |
$86K |
| E0570 |
Nebulizer with compression |
1,228 |
1,178 |
$73K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
400 |
385 |
$60K |
| B4155 |
Ef incomplete/modular |
184 |
147 |
$56K |
| A4259 |
Lancets per box |
7,318 |
6,512 |
$50K |
| T4521 |
Adult size brief/diaper sm |
448 |
439 |
$46K |
| B4161 |
Ef ped hydrolyzed/amino acid |
48 |
48 |
$43K |
| A4670 |
Automatic bp monitor, dial |
756 |
733 |
$39K |
| A7000 |
Disposable canister for pump |
755 |
735 |
$38K |
| A5063 |
Drain ostomy pouch w/flange |
462 |
438 |
$32K |
| A7002 |
Tubing used w suction pump |
761 |
729 |
$12K |
| A6250 |
Skin seal protect moisturizr |
1,353 |
1,168 |
$12K |
| A4322 |
Irrigation syringe |
1,051 |
998 |
$9K |
| A7003 |
Nebulizer administration set |
2,506 |
2,418 |
$8K |
| B4100 |
Food thickener oral |
139 |
136 |
$6K |
| A6216 |
Non-sterile gauze<=16 sq in |
1,408 |
1,285 |
$6K |
| A4406 |
Pectin based ostomy paste |
465 |
454 |
$6K |
| A4402 |
Lubricant per ounce |
941 |
741 |
$4K |
| T1999 |
Noc retail items andsupplies |
1,653 |
1,163 |
$4K |
| A4245 |
Alcohol wipes per box |
2,408 |
2,195 |
$4K |
| A4628 |
Oropharyngeal suction cath |
664 |
642 |
$4K |
| A5120 |
Skin barrier, wipe or swab |
503 |
442 |
$4K |
| A4456 |
Adhesive remover, wipes |
420 |
387 |
$3K |
| A4371 |
Skin barrier powder per oz |
119 |
119 |
$1K |
| E0240 |
Bath/shower chair |
24 |
12 |
$894.48 |
| A4358 |
Urinary leg or abdomen bag |
76 |
76 |
$733.58 |
| A4450 |
Non-waterproof tape |
97 |
91 |
$433.22 |
| A4357 |
Bedside drainage bag |
41 |
37 |
$210.27 |
| A4520 |
Incontinence garment anytype |
38 |
28 |
$0.00 |