| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Large disposable underpad |
26,126 |
25,965 |
$958K |
| T4535 |
Disposable liner/shield/pad |
15,566 |
14,550 |
$437K |
| T4534 |
Youth size pull-on |
3,903 |
3,884 |
$386K |
| T4527 |
Adult size pull-on lg |
7,093 |
7,060 |
$324K |
| T4526 |
Adult size pull-on med |
7,804 |
7,763 |
$278K |
| T4523 |
Adult size brief/diaper lg |
3,967 |
3,939 |
$257K |
| A4351 |
Straight tip urine catheter |
863 |
830 |
$230K |
| A6250 |
Skin seal protect moisturizr |
20,444 |
20,315 |
$216K |
| T4528 |
Adult size pull-on xl |
4,599 |
4,570 |
$214K |
| B4035 |
Enteral feed supp pump per d |
1,381 |
1,361 |
$211K |
| T4522 |
Adult size brief/diaper med |
3,150 |
3,125 |
$177K |
| A4335 |
Incontinence supply |
20,403 |
20,277 |
$172K |
| B9998 |
Enteral supp not otherwise c |
2,127 |
2,025 |
$164K |
| T4530 |
Ped size brief/diaper lg |
2,761 |
2,732 |
$160K |
| T4524 |
Adult size brief/diaper xl |
1,929 |
1,912 |
$110K |
| A4385 |
Ost skn barrier sld ext wear |
881 |
835 |
$106K |
| A4409 |
Ost skn barr convex <=4 sq i |
551 |
541 |
$103K |
| B4088 |
Gastro/jejuno tube, low-pro |
792 |
787 |
$87K |
| S9999 |
Sales tax |
8,700 |
8,580 |
$85K |
| A4322 |
Irrigation syringe |
1,936 |
1,836 |
$81K |
| A4425 |
Ost pch drain for barrier fl |
510 |
501 |
$59K |
| A4927 |
Non-sterile gloves |
3,986 |
3,935 |
$54K |
| T4525 |
Adult size pull-on sm |
1,627 |
1,620 |
$53K |
| T4537 |
Reusable underpad bed size |
2,068 |
2,067 |
$33K |
| T4521 |
Adult size brief/diaper sm |
288 |
288 |
$15K |
| A4394 |
Ostomy pouch liq deodorant |
809 |
801 |
$14K |
| A4456 |
Adhesive remover, wipes |
1,009 |
1,003 |
$13K |
| A4357 |
Bedside drainage bag |
461 |
457 |
$11K |
| A5120 |
Skin barrier, wipe or swab |
1,136 |
1,132 |
$10K |
| A4406 |
Pectin based ostomy paste |
388 |
385 |
$8K |
| A6402 |
Sterile gauze <= 16 sq in |
754 |
728 |
$8K |
| A4362 |
Solid skin barrier |
105 |
101 |
$6K |
| A6446 |
Conform band s w>=3" <5"/yd |
41 |
40 |
$6K |
| A4371 |
Skin barrier powder per oz |
541 |
535 |
$5K |
| A4358 |
Urinary leg or abdomen bag |
108 |
104 |
$2K |
| A9286 |
Any hygienic item, device |
93 |
92 |
$1K |
| A4310 |
Insert tray w/o bag/cath |
49 |
49 |
$1K |
| A6216 |
Non-sterile gauze<=16 sq in |
75 |
75 |
$983.15 |
| A4338 |
Indwelling catheter latex |
36 |
36 |
$897.83 |
| A4402 |
Lubricant per ounce |
52 |
51 |
$233.64 |
| B4160 |
Ef ped caloric dense>/=0.7kc |
605 |
584 |
$0.00 |
| B4150 |
Ef complet w/intact nutrient |
12 |
12 |
$0.00 |