| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
30,841 |
30,064 |
$2.54M |
| T4522 |
Adult size brief/diaper med |
14,053 |
13,695 |
$1.57M |
| T4523 |
Adult size brief/diaper lg |
10,673 |
10,436 |
$1.56M |
| T4537 |
Reusable underpad bed size |
25,590 |
24,968 |
$890K |
| T4524 |
Adult size brief/diaper xl |
4,970 |
4,855 |
$759K |
| T4533 |
Youth size brief/diaper |
6,455 |
6,313 |
$579K |
| T4521 |
Adult size brief/diaper sm |
4,750 |
4,629 |
$500K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
877 |
840 |
$158K |
| T4535 |
Disposable liner/shield/pad |
6,239 |
6,093 |
$134K |
| B4035 |
Enteral feed supp pump per d |
697 |
672 |
$118K |
| B4150 |
Ef complet w/intact nutrient |
484 |
460 |
$100K |
| A4927 |
Non-sterile gloves |
12,997 |
12,618 |
$59K |
| A6402 |
Sterile gauze <= 16 sq in |
709 |
678 |
$15K |
| A4322 |
Irrigation syringe |
622 |
595 |
$8K |
| T4530 |
Ped size brief/diaper lg |
55 |
53 |
$5K |
| B4088 |
Gastro/jejuno tube, low-pro |
12 |
12 |
$2K |
| A4209 |
5+ cc sterile syringe&needle |
78 |
74 |
$921.30 |
| T4539 |
Reuse diaper/brief any size |
14 |
13 |
$456.96 |
| A4452 |
Waterproof tape |
48 |
48 |
$275.00 |