| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6197 |
Alginate drsg >16 <=48 sq in |
5,059 |
4,665 |
$1.63M |
| T4527 |
Adult size pull-on lg |
14,637 |
14,279 |
$1.28M |
| B4035 |
Enteral feed supp pump per d |
12,181 |
9,959 |
$1.04M |
| A4927 |
Non-sterile gloves |
51,816 |
50,453 |
$1.01M |
| A6212 |
Foam drg <=16 sq in w/border |
7,764 |
7,028 |
$900K |
| T4528 |
Adult size pull-on xl |
9,949 |
9,715 |
$868K |
| T4526 |
Adult size pull-on med |
11,612 |
11,280 |
$860K |
| A6021 |
Collagen dressing <=16 sq in |
3,431 |
3,203 |
$801K |
| S9999 |
Sales tax |
15,616 |
14,324 |
$780K |
| E1161 |
Manual adult wc w tiltinspac |
892 |
796 |
$709K |
| T4537 |
Reusable underpad bed size |
19,353 |
18,943 |
$683K |
| T4535 |
Disposable liner/shield/pad |
21,629 |
21,031 |
$682K |
| A6196 |
Alginate dressing <=16 sq in |
5,821 |
5,448 |
$631K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
2,546 |
2,384 |
$629K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
3,496 |
3,149 |
$606K |
| T4541 |
Large disposable underpad |
13,884 |
13,520 |
$601K |
| B4153 |
Ef hydrolyzed/amino acids |
2,185 |
1,366 |
$522K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
7,503 |
6,901 |
$512K |
| B4152 |
Ef calorie dense>/=1.5kcal |
6,476 |
4,493 |
$450K |
| T4524 |
Adult size brief/diaper xl |
4,739 |
4,612 |
$445K |
| T4523 |
Adult size brief/diaper lg |
4,701 |
4,590 |
$383K |
| B4150 |
Ef complet w/intact nutrient |
7,112 |
4,586 |
$339K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
3,589 |
3,361 |
$288K |
| A6446 |
Conform band s w>=3" <5"/yd |
10,195 |
9,372 |
$250K |
| B4154 |
Ef spec metabolic noninherit |
2,025 |
1,416 |
$243K |
| T4544 |
Adlt disp und/pull on abv xl |
1,379 |
1,351 |
$217K |
| A4385 |
Ost skn barrier sld ext wear |
4,703 |
4,283 |
$210K |
| A4452 |
Waterproof tape |
9,315 |
8,586 |
$191K |
| A4335 |
Incontinence supply |
6,635 |
6,468 |
$171K |
| K0005 |
Ultralightweight wheelchair |
76 |
71 |
$153K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
2,561 |
2,393 |
$147K |
| A6452 |
High compres band w>=3"<5"yd |
453 |
423 |
$128K |
| T4522 |
Adult size brief/diaper med |
1,840 |
1,789 |
$126K |
| E1028 |
W/c manual swingaway |
1,379 |
961 |
$124K |
| A4409 |
Ost skn barr convex <=4 sq i |
2,498 |
2,294 |
$123K |
| E0973 |
W/ch access det adj armrest |
727 |
677 |
$105K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
949 |
838 |
$98K |
| A4407 |
Ext wear ost skn barr <=4sq" |
1,365 |
1,258 |
$86K |
| E2611 |
Gen use back cush wdth <22in |
329 |
307 |
$80K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
2,210 |
2,022 |
$78K |
| T4525 |
Adult size pull-on sm |
1,039 |
998 |
$76K |
| A5056 |
1 pc ost pouch w filter |
1,004 |
904 |
$76K |
| A4425 |
Ost pch drain for barrier fl |
2,404 |
2,177 |
$74K |
| B9002 |
Enter nutr inf pump any type |
1,547 |
1,505 |
$71K |
| B4034 |
Enter feed supkit syr by day |
1,499 |
1,427 |
$69K |
| E0955 |
Cushioned headrest |
854 |
747 |
$58K |
| A6454 |
Self-adher band w>=3" <5"/yd |
1,144 |
1,062 |
$54K |
| A6449 |
Lt compres band >=3" <5"/yd |
515 |
476 |
$53K |
| A6216 |
Non-sterile gauze<=16 sq in |
10,821 |
10,139 |
$51K |
| A4351 |
Straight tip urine catheter |
736 |
672 |
$50K |
| A4362 |
Solid skin barrier |
1,198 |
1,099 |
$48K |
| A5057 |
1 pc ost pou w built-in conv |
369 |
338 |
$46K |
| K0001 |
Standard wheelchair |
3,389 |
3,266 |
$43K |
| E2231 |
Solid seat support base |
305 |
287 |
$42K |
| E0971 |
Wheelchair anti-tipping devi |
544 |
502 |
$41K |
| A6266 |
Impreg gauze no h20/sal/yard |
532 |
474 |
$37K |
| A5063 |
Drain ostomy pouch w/flange |
1,881 |
1,734 |
$37K |
| E2203 |
Frame depth less than 22 in |
80 |
72 |
$36K |
| E2607 |
Skin pro/pos wc cus wd <22in |
145 |
133 |
$36K |
| A4394 |
Ostomy pouch liq deodorant |
2,711 |
2,449 |
$34K |
| A6219 |
Gauze <= 16 sq in w/border |
2,255 |
2,172 |
$34K |
| K0004 |
High strength ltwt whlchr |
158 |
148 |
$32K |
| A5120 |
Skin barrier, wipe or swab |
6,088 |
5,527 |
$30K |
| E2615 |
Pos back post/lat wdth <22in |
65 |
64 |
$27K |
| A4456 |
Adhesive remover, wipes |
4,176 |
3,795 |
$26K |
| T4543 |
Adult disp brief/diap abv xl |
114 |
111 |
$22K |
| B4087 |
Gastro/jejuno tube, std |
1,469 |
1,434 |
$21K |
| A4357 |
Bedside drainage bag |
2,686 |
2,496 |
$20K |
| A6248 |
Hydrogel drsg gel filler |
647 |
609 |
$18K |
| A6441 |
Pad band w>=3" <5"/yd |
921 |
851 |
$18K |
| E0260 |
Hosp bed semi-electr w/ matt |
932 |
903 |
$18K |
| K0040 |
Adjustable angle footplate |
148 |
139 |
$16K |
| A6443 |
Conform band n/s w>=3"<5"/yd |
911 |
861 |
$16K |
| A6457 |
Tubular dressing |
1,070 |
1,016 |
$16K |
| E0143 |
Walker folding wheeled w/o s |
539 |
513 |
$14K |
| E0630 |
Patient lift hydraulic |
419 |
405 |
$13K |
| E0951 |
Loop heel |
457 |
422 |
$13K |
| A4450 |
Non-waterproof tape |
6,452 |
6,033 |
$13K |
| A4349 |
Disposable male external cat |
420 |
401 |
$12K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
47 |
41 |
$12K |
| A4367 |
Ostomy belt |
1,829 |
1,684 |
$10K |
| E2601 |
Gen w/c cushion wdth < 22 in |
247 |
234 |
$10K |
| A6010 |
Collagen based wound filler |
30 |
26 |
$8K |
| A4406 |
Pectin based ostomy paste |
1,038 |
927 |
$8K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
149 |
141 |
$8K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
239 |
225 |
$7K |
| K0108 |
W/c component-accessory nos |
37 |
24 |
$7K |
| A4371 |
Skin barrier powder per oz |
2,092 |
1,960 |
$5K |
| A6545 |
Grad com non-elastic bk surg |
213 |
165 |
$4K |
| A6199 |
Alginate drsg wound filler |
44 |
43 |
$4K |
| E0149 |
Heavy duty wheeled walker |
243 |
242 |
$4K |
| A4314 |
Cath w/drainage 2-way latex |
382 |
367 |
$3K |
| E0294 |
Hosp bed semi-elect w/ mattr |
31 |
30 |
$3K |
| A4402 |
Lubricant per ounce |
877 |
821 |
$3K |
| A6207 |
Contact layer >16<= 48 sq in |
40 |
37 |
$3K |
| A6402 |
Sterile gauze <= 16 sq in |
737 |
675 |
$3K |
| B4155 |
Ef incomplete/modular |
827 |
477 |
$2K |
| A4322 |
Irrigation syringe |
47 |
47 |
$2K |
| A4338 |
Indwelling catheter latex |
286 |
255 |
$2K |
| B4088 |
Gastro/jejuno tube, low-pro |
135 |
135 |
$2K |
| K0739 |
Repair/svc dme non-oxygen eq |
29 |
28 |
$2K |
| A4520 |
Incontinence garment anytype |
69 |
57 |
$2K |
| E0156 |
Walker seat attachment |
164 |
159 |
$1K |
| K0195 |
Elevating whlchair leg rests |
239 |
225 |
$1K |
| A4358 |
Urinary leg or abdomen bag |
186 |
172 |
$972.61 |
| K0002 |
Stnd hemi (low seat) whlchr |
100 |
95 |
$639.45 |
| A6445 |
Conform band s w <3"/yd |
26 |
26 |
$491.99 |
| A5061 |
Pouch drainable w barrier at |
12 |
12 |
$326.10 |
| A6261 |
Wound filler gel/paste /oz |
18 |
18 |
$44.47 |
| E1399 |
Durable medical equipment mi |
20 |
20 |
$6.59 |