| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4534 |
Youth size pull-on |
20,292 |
19,584 |
$2.24M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
11,834 |
11,128 |
$1.71M |
| B4035 |
Enteral feed supp pump per d |
5,798 |
5,081 |
$1.66M |
| B4161 |
Ef ped hydrolyzed/amino acid |
1,886 |
1,670 |
$1.17M |
| T4530 |
Ped size brief/diaper lg |
10,641 |
10,004 |
$862K |
| B4149 |
Ef blenderized foods |
1,451 |
1,267 |
$665K |
| B9002 |
Enter nutr inf pump any type |
9,786 |
6,022 |
$644K |
| T4525 |
Adult size pull-on sm |
6,194 |
5,948 |
$643K |
| B4150 |
Ef complet w/intact nutrient |
3,786 |
3,426 |
$544K |
| T4521 |
Adult size brief/diaper sm |
6,287 |
5,825 |
$495K |
| T4522 |
Adult size brief/diaper med |
4,846 |
4,536 |
$396K |
| T2029 |
Special med equip, noswaiver |
2,403 |
2,247 |
$381K |
| T4526 |
Adult size pull-on med |
3,385 |
3,264 |
$361K |
| B4034 |
Enter feed supkit syr by day |
2,182 |
1,917 |
$319K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,245 |
1,087 |
$231K |
| B4088 |
Gastro/jejuno tube, low-pro |
1,883 |
1,670 |
$205K |
| T2028 |
Special supply, nos waiver |
1,205 |
943 |
$177K |
| T4523 |
Adult size brief/diaper lg |
1,829 |
1,669 |
$146K |
| T4531 |
Ped size pull-on sm/med |
1,073 |
982 |
$108K |
| T4528 |
Adult size pull-on xl |
680 |
622 |
$87K |
| B4155 |
Ef incomplete/modular |
987 |
880 |
$68K |
| A4554 |
Disposable underpads |
2,800 |
2,433 |
$66K |
| A4927 |
Non-sterile gloves |
3,385 |
3,057 |
$65K |
| T4527 |
Adult size pull-on lg |
408 |
384 |
$40K |
| A4351 |
Straight tip urine catheter |
92 |
73 |
$17K |
| A4213 |
20+ cc syringe only |
646 |
558 |
$12K |
| A6212 |
Foam drg <=16 sq in w/border |
145 |
124 |
$12K |
| T4524 |
Adult size brief/diaper xl |
85 |
76 |
$10K |
| A4657 |
Syringe w/wo needle |
4,420 |
3,901 |
$10K |
| A6402 |
Sterile gauze <= 16 sq in |
1,308 |
1,148 |
$6K |
| T4532 |
Ped size pull-on lg |
38 |
38 |
$3K |
| A4452 |
Waterproof tape |
336 |
293 |
$1K |
| A5120 |
Skin barrier, wipe or swab |
138 |
132 |
$961.50 |