| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
19,132 |
18,354 |
$1.65M |
| T4526 |
Adult size pull-on med |
16,861 |
16,139 |
$1.31M |
| T4535 |
Disposable liner/shield/pad |
19,730 |
18,791 |
$1.26M |
| T4528 |
Adult size pull-on xl |
12,799 |
12,204 |
$1.18M |
| A4927 |
Non-sterile gloves |
61,735 |
55,820 |
$982K |
| A6212 |
Foam drg <=16 sq in w/border |
3,798 |
3,146 |
$673K |
| A6197 |
Alginate drsg >16 <=48 sq in |
1,793 |
1,399 |
$472K |
| T4542 |
Small disposable underpad |
11,464 |
11,000 |
$225K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
2,075 |
1,417 |
$209K |
| T4524 |
Adult size brief/diaper xl |
2,146 |
2,029 |
$195K |
| T4541 |
Large disposable underpad |
10,389 |
9,988 |
$194K |
| T4523 |
Adult size brief/diaper lg |
2,334 |
2,188 |
$191K |
| A6021 |
Collagen dressing <=16 sq in |
854 |
732 |
$157K |
| A6196 |
Alginate dressing <=16 sq in |
1,695 |
1,331 |
$124K |
| T4537 |
Reusable underpad bed size |
2,691 |
2,533 |
$119K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
350 |
299 |
$111K |
| A6446 |
Conform band s w>=3" <5"/yd |
3,194 |
2,614 |
$77K |
| T4525 |
Adult size pull-on sm |
1,186 |
1,134 |
$66K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
1,373 |
1,158 |
$62K |
| T4522 |
Adult size brief/diaper med |
480 |
457 |
$35K |
| A4452 |
Waterproof tape |
2,613 |
2,106 |
$30K |
| B4035 |
Enteral feed supp pump per d |
245 |
151 |
$27K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
124 |
112 |
$22K |
| T4544 |
Adlt disp und/pull on abv xl |
257 |
250 |
$16K |
| B4152 |
Ef calorie dense>/=1.5kcal |
129 |
84 |
$12K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
177 |
157 |
$10K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
294 |
255 |
$10K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
141 |
126 |
$9K |
| A6216 |
Non-sterile gauze<=16 sq in |
2,395 |
1,715 |
$7K |
| A6454 |
Self-adher band w>=3" <5"/yd |
108 |
96 |
$5K |
| A4385 |
Ost skn barrier sld ext wear |
126 |
98 |
$5K |
| A6199 |
Alginate drsg wound filler |
14 |
14 |
$3K |
| A4520 |
Incontinence garment anytype |
5,039 |
3,541 |
$3K |
| A4450 |
Non-waterproof tape |
854 |
738 |
$3K |
| A6266 |
Impreg gauze no h20/sal/yard |
15 |
12 |
$3K |
| A6449 |
Lt compres band >=3" <5"/yd |
17 |
13 |
$1K |
| A4357 |
Bedside drainage bag |
205 |
169 |
$834.20 |
| K0001 |
Standard wheelchair |
78 |
51 |
$816.22 |
| E1028 |
W/c manual swingaway |
265 |
165 |
$597.28 |
| A4456 |
Adhesive remover, wipes |
90 |
69 |
$520.07 |
| A5120 |
Skin barrier, wipe or swab |
118 |
90 |
$412.67 |
| A6457 |
Tubular dressing |
32 |
28 |
$403.32 |
| A4338 |
Indwelling catheter latex |
106 |
86 |
$335.06 |
| A6219 |
Gauze <= 16 sq in w/border |
13 |
12 |
$162.26 |
| A4554 |
Disposable underpads |
1,315 |
1,112 |
$141.64 |
| A4358 |
Urinary leg or abdomen bag |
57 |
45 |
$107.85 |