| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Large disposable underpad |
15,103 |
14,735 |
$548K |
| T4527 |
Adult size pull-on lg |
5,149 |
5,040 |
$459K |
| T4526 |
Adult size pull-on med |
5,401 |
5,253 |
$458K |
| T4523 |
Adult size brief/diaper lg |
2,822 |
2,747 |
$337K |
| T4534 |
Youth size pull-on |
3,635 |
3,448 |
$293K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
855 |
832 |
$278K |
| T4522 |
Adult size brief/diaper med |
2,874 |
2,802 |
$267K |
| T4528 |
Adult size pull-on xl |
2,727 |
2,645 |
$260K |
| T4524 |
Adult size brief/diaper xl |
1,541 |
1,493 |
$215K |
| T4533 |
Youth size brief/diaper |
2,258 |
2,154 |
$192K |
| T4535 |
Disposable liner/shield/pad |
6,192 |
6,012 |
$191K |
| T4525 |
Adult size pull-on sm |
2,031 |
1,954 |
$168K |
| A5121 |
Solid skin barrier 6x6 |
787 |
736 |
$104K |
| T4521 |
Adult size brief/diaper sm |
379 |
367 |
$33K |
| A4357 |
Bedside drainage bag |
1,036 |
997 |
$18K |
| A4351 |
Straight tip urine catheter |
93 |
85 |
$14K |
| A5120 |
Skin barrier, wipe or swab |
1,179 |
1,118 |
$9K |
| A4456 |
Adhesive remover, wipes |
896 |
851 |
$7K |
| A4394 |
Ostomy pouch liq deodorant |
133 |
124 |
$4K |
| A4358 |
Urinary leg or abdomen bag |
177 |
173 |
$2K |
| A4425 |
Ost pch drain for barrier fl |
12 |
12 |
$781.12 |
| A4385 |
Ost skn barrier sld ext wear |
19 |
12 |
$659.50 |
| A4406 |
Pectin based ostomy paste |
13 |
12 |
$235.93 |
| A4371 |
Skin barrier powder per oz |
83 |
75 |
$205.90 |