| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Large disposable underpad |
256,953 |
252,667 |
$14.32M |
| T4535 |
Disposable liner/shield/pad |
161,823 |
149,435 |
$8.98M |
| T4527 |
Adult size pull-on lg |
87,677 |
86,012 |
$5.60M |
| T4526 |
Adult size pull-on med |
83,622 |
82,132 |
$4.41M |
| T4528 |
Adult size pull-on xl |
55,424 |
54,405 |
$3.64M |
| T4523 |
Adult size brief/diaper lg |
34,256 |
33,731 |
$3.29M |
| T4534 |
Youth size pull-on |
13,194 |
13,084 |
$2.78M |
| A6250 |
Skin seal protect moisturizr |
188,885 |
186,185 |
$2.66M |
| A4351 |
Straight tip urine catheter |
5,656 |
5,372 |
$2.50M |
| T4524 |
Adult size brief/diaper xl |
24,874 |
24,504 |
$2.24M |
| A4335 |
Incontinence supply |
181,521 |
178,943 |
$1.87M |
| T4522 |
Adult size brief/diaper med |
22,784 |
22,456 |
$1.73M |
| A6197 |
Alginate drsg >16 <=48 sq in |
1,158 |
1,094 |
$1.02M |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
1,208 |
1,136 |
$868K |
| A4927 |
Non-sterile gloves |
39,461 |
38,518 |
$785K |
| A4409 |
Ost skn barr convex <=4 sq i |
3,132 |
3,047 |
$706K |
| T4530 |
Ped size brief/diaper lg |
6,288 |
6,227 |
$692K |
| T4537 |
Reusable underpad bed size |
22,636 |
22,390 |
$661K |
| T4525 |
Adult size pull-on sm |
13,001 |
12,770 |
$646K |
| A4385 |
Ost skn barrier sld ext wear |
3,750 |
3,699 |
$623K |
| A6212 |
Foam drg <=16 sq in w/border |
1,179 |
1,100 |
$465K |
| A4425 |
Ost pch drain for barrier fl |
4,094 |
4,006 |
$451K |
| A6446 |
Conform band s w>=3" <5"/yd |
5,187 |
5,047 |
$444K |
| A4407 |
Ext wear ost skn barr <=4sq" |
1,288 |
1,271 |
$395K |
| B4035 |
Enteral feed supp pump per d |
1,666 |
1,646 |
$275K |
| T4532 |
Ped size pull-on lg |
1,195 |
1,172 |
$220K |
| A4410 |
Ost skn barr extnd >4 sq |
770 |
752 |
$195K |
| T4521 |
Adult size brief/diaper sm |
2,571 |
2,548 |
$170K |
| B9998 |
Enteral supp not otherwise c |
1,882 |
1,823 |
$169K |
| A6454 |
Self-adher band w>=3" <5"/yd |
1,157 |
1,138 |
$168K |
| A4357 |
Bedside drainage bag |
4,509 |
4,439 |
$160K |
| B4088 |
Gastro/jejuno tube, low-pro |
1,015 |
1,005 |
$153K |
| A4362 |
Solid skin barrier |
1,592 |
1,573 |
$150K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
922 |
903 |
$150K |
| A4322 |
Irrigation syringe |
2,278 |
2,080 |
$140K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
1,173 |
1,151 |
$137K |
| A5063 |
Drain ostomy pouch w/flange |
1,404 |
1,374 |
$135K |
| A6216 |
Non-sterile gauze<=16 sq in |
8,078 |
7,966 |
$134K |
| A6196 |
Alginate dressing <=16 sq in |
281 |
272 |
$121K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
2,346 |
2,301 |
$106K |
| A6402 |
Sterile gauze <= 16 sq in |
4,955 |
4,801 |
$95K |
| A4358 |
Urinary leg or abdomen bag |
2,862 |
2,797 |
$94K |
| A4406 |
Pectin based ostomy paste |
2,828 |
2,796 |
$94K |
| A4349 |
Disposable male external cat |
1,378 |
1,351 |
$91K |
| A4338 |
Indwelling catheter latex |
2,282 |
2,222 |
$89K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
854 |
831 |
$88K |
| A4394 |
Ostomy pouch liq deodorant |
3,780 |
3,740 |
$88K |
| A5056 |
1 pc ost pouch w filter |
494 |
487 |
$86K |
| A4456 |
Adhesive remover, wipes |
6,482 |
6,420 |
$81K |
| A5120 |
Skin barrier, wipe or swab |
7,247 |
7,195 |
$72K |
| A4310 |
Insert tray w/o bag/cath |
2,353 |
2,319 |
$68K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
918 |
904 |
$67K |
| A5057 |
1 pc ost pou w built-in conv |
203 |
197 |
$62K |
| A4333 |
Urinary cath anchor device |
819 |
810 |
$58K |
| A6235 |
Hydrocolld drg >16<=48 w/o b |
116 |
110 |
$51K |
| A4424 |
Ost pch drain w bar & filter |
319 |
291 |
$47K |
| A4371 |
Skin barrier powder per oz |
3,260 |
3,241 |
$44K |
| A5061 |
Pouch drainable w barrier at |
272 |
265 |
$38K |
| A6266 |
Impreg gauze no h20/sal/yard |
267 |
258 |
$26K |
| A4388 |
Drainable pch w ex wear barr |
144 |
141 |
$25K |
| A4455 |
Adhesive remover per ounce |
876 |
864 |
$17K |
| A4217 |
Sterile water/saline, 500 ml |
186 |
182 |
$14K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
76 |
71 |
$14K |
| A6219 |
Gauze <= 16 sq in w/border |
257 |
250 |
$14K |
| A6240 |
Hydrocolld drg filler paste |
141 |
136 |
$13K |
| A4367 |
Ostomy belt |
1,379 |
1,374 |
$13K |
| T4536 |
Reusable pull-on any size |
1,126 |
1,106 |
$13K |
| A4419 |
Ost pch for bar w flange/flt |
96 |
93 |
$12K |
| A4364 |
Adhesive, liquid or equal |
155 |
155 |
$8K |
| A4320 |
Irrigation tray |
200 |
197 |
$7K |
| A6248 |
Hydrogel drsg gel filler |
55 |
53 |
$7K |
| A4402 |
Lubricant per ounce |
1,303 |
1,293 |
$5K |
| A6220 |
Gauze >16 <=48 sq in w/bordr |
36 |
36 |
$5K |
| T4543 |
Adult disp brief/diap abv xl |
50 |
50 |
$4K |
| A4353 |
Intermittent urinary cath |
15 |
13 |
$2K |
| A6257 |
Transparent film <= 16 sq in |
64 |
63 |
$908.71 |
| A4369 |
Skin barrier liquid per oz |
161 |
158 |
$808.18 |
| A4247 |
Betadine/iodine swabs/wipes |
86 |
85 |
$569.69 |
| A4239 |
Non-adju cgm supply allow |
13 |
13 |
$510.01 |
| A9900 |
Supply/accessory/service |
13 |
12 |
$368.05 |
| A4331 |
Extension drainage tubing |
12 |
12 |
$182.05 |
| A4245 |
Alcohol wipes per box |
12 |
12 |
$21.94 |