| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4526 |
Adult size pull-on med |
1,761 |
1,702 |
$201K |
| T4541 |
Large disposable underpad |
2,114 |
1,978 |
$128K |
| T4534 |
Youth size pull-on |
1,062 |
1,028 |
$92K |
| B4100 |
Food thickener oral |
879 |
783 |
$69K |
| T4527 |
Adult size pull-on lg |
553 |
516 |
$61K |
| B4035 |
Enteral feed supp pump per d |
2,274 |
1,809 |
$32K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,297 |
1,053 |
$27K |
| T4528 |
Adult size pull-on xl |
123 |
122 |
$20K |
| T4525 |
Adult size pull-on sm |
201 |
201 |
$19K |
| B4150 |
Ef complet w/intact nutrient |
1,562 |
1,315 |
$17K |
| B4154 |
Ef spec metabolic noninherit |
186 |
150 |
$6K |
| T4535 |
Disposable liner/shield/pad |
135 |
134 |
$5K |
| T4530 |
Ped size brief/diaper lg |
24 |
24 |
$3K |
| A4314 |
Cath w/drainage 2-way latex |
1,477 |
1,423 |
$2K |
| A4357 |
Bedside drainage bag |
1,905 |
1,818 |
$2K |
| B4034 |
Enter feed supkit syr by day |
432 |
356 |
$1K |
| B4036 |
Enteral feed sup kit grav by |
269 |
232 |
$854.05 |
| A4409 |
Ost skn barr convex <=4 sq i |
56 |
53 |
$757.81 |
| A5061 |
Pouch drainable w barrier at |
46 |
38 |
$747.02 |
| A5063 |
Drain ostomy pouch w/flange |
133 |
123 |
$678.74 |
| B9002 |
Enter nutr inf pump any type |
276 |
268 |
$325.72 |
| E0776 |
Iv pole |
827 |
795 |
$262.29 |
| A4425 |
Ost pch drain for barrier fl |
24 |
24 |
$220.65 |
| A4629 |
Tracheostomy care kit |
41 |
39 |
$185.29 |
| B4087 |
Gastro/jejuno tube, std |
44 |
44 |
$5.08 |