| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
1,893 |
1,786 |
$1.35M |
| A4554 |
Disposable underpads |
30,995 |
29,234 |
$876K |
| T4527 |
Adult size pull-on lg |
9,751 |
9,267 |
$833K |
| T4526 |
Adult size pull-on med |
9,702 |
9,251 |
$789K |
| A9900 |
Supply/accessory/service |
9,653 |
8,108 |
$722K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
4,449 |
4,309 |
$710K |
| T4534 |
Youth size pull-on |
5,348 |
5,182 |
$690K |
| T4528 |
Adult size pull-on xl |
6,173 |
5,872 |
$675K |
| E1399 |
Durable medical equipment mi |
6,030 |
5,281 |
$674K |
| A4353 |
Intermittent urinary cath |
642 |
615 |
$570K |
| A4927 |
Non-sterile gloves |
32,199 |
30,264 |
$518K |
| A4245 |
Alcohol wipes per box |
34,260 |
31,943 |
$500K |
| A4216 |
Sterile water/saline, 10 ml |
3,166 |
3,090 |
$410K |
| A4409 |
Ost skn barr convex <=4 sq i |
1,039 |
995 |
$308K |
| B4150 |
Ef complet w/intact nutrient |
2,119 |
2,028 |
$290K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,277 |
1,235 |
$247K |
| T4535 |
Disposable liner/shield/pad |
5,117 |
4,835 |
$219K |
| A4362 |
Solid skin barrier |
2,116 |
2,046 |
$219K |
| T4544 |
Adlt disp und/pull on abv xl |
1,702 |
1,621 |
$207K |
| T4523 |
Adult size brief/diaper lg |
2,429 |
2,310 |
$201K |
| T4525 |
Adult size pull-on sm |
2,493 |
2,333 |
$191K |
| T4524 |
Adult size brief/diaper xl |
2,070 |
1,970 |
$188K |
| E0603 |
Electric breast pump |
2,086 |
2,057 |
$171K |
| B4034 |
Enter feed supkit syr by day |
1,366 |
1,326 |
$140K |
| T4530 |
Ped size brief/diaper lg |
1,583 |
1,533 |
$133K |
| T4532 |
Ped size pull-on lg |
1,035 |
1,006 |
$121K |
| T4522 |
Adult size brief/diaper med |
1,374 |
1,312 |
$108K |
| A4371 |
Skin barrier powder per oz |
1,697 |
1,585 |
$104K |
| A4452 |
Waterproof tape |
2,494 |
2,417 |
$87K |
| B9998 |
Enteral supp not otherwise c |
791 |
741 |
$80K |
| T4543 |
Adult disp brief/diap abv xl |
735 |
714 |
$73K |
| A4385 |
Ost skn barrier sld ext wear |
2,061 |
1,929 |
$70K |
| A4450 |
Non-waterproof tape |
1,188 |
1,164 |
$60K |
| A6197 |
Alginate drsg >16 <=48 sq in |
130 |
128 |
$56K |
| A4425 |
Ost pch drain for barrier fl |
1,083 |
1,035 |
$53K |
| A6402 |
Sterile gauze <= 16 sq in |
2,473 |
2,429 |
$51K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
128 |
125 |
$39K |
| T4533 |
Youth size brief/diaper |
378 |
367 |
$36K |
| A6212 |
Foam drg <=16 sq in w/border |
197 |
194 |
$35K |
| S5199 |
Personal care item nos each |
640 |
558 |
$34K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
162 |
157 |
$31K |
| A4406 |
Pectin based ostomy paste |
1,464 |
1,430 |
$30K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
145 |
142 |
$30K |
| T4521 |
Adult size brief/diaper sm |
326 |
322 |
$29K |
| A5061 |
Pouch drainable w barrier at |
289 |
273 |
$29K |
| A6446 |
Conform band s w>=3" <5"/yd |
1,108 |
1,080 |
$29K |
| T4529 |
Ped size brief/diaper sm/med |
272 |
268 |
$22K |
| A4456 |
Adhesive remover, wipes |
2,765 |
2,671 |
$18K |
| B4154 |
Ef spec metabolic noninherit |
123 |
120 |
$17K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
192 |
189 |
$15K |
| A5120 |
Skin barrier, wipe or swab |
3,104 |
2,927 |
$15K |
| A4394 |
Ostomy pouch liq deodorant |
1,842 |
1,783 |
$13K |
| A6449 |
Lt compres band >=3" <5"/yd |
209 |
202 |
$7K |
| A5063 |
Drain ostomy pouch w/flange |
288 |
274 |
$7K |
| A4357 |
Bedside drainage bag |
118 |
115 |
$7K |
| E0570 |
Nebulizer with compression |
89 |
87 |
$7K |
| A6216 |
Non-sterile gauze<=16 sq in |
576 |
561 |
$4K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
58 |
58 |
$3K |
| T4537 |
Reusable underpad bed size |
636 |
619 |
$3K |
| A6258 |
Transparent film >16<=48 in |
25 |
24 |
$3K |
| A4407 |
Ext wear ost skn barr <=4sq" |
12 |
12 |
$2K |
| A7003 |
Nebulizer administration set |
150 |
145 |
$156.11 |
| A4455 |
Adhesive remover per ounce |
50 |
48 |
$88.54 |
| A7015 |
Aerosol mask used w nebulize |
69 |
69 |
$3.37 |