| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4534 |
Youth size pull-on |
2,887 |
2,609 |
$399K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
2,086 |
1,055 |
$143K |
| T4541 |
Large disposable underpad |
1,344 |
1,216 |
$74K |
| A4362 |
Solid skin barrier |
80 |
66 |
$4K |
| A4385 |
Ost skn barrier sld ext wear |
61 |
56 |
$3K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
51 |
40 |
$2K |
| A4394 |
Ostomy pouch liq deodorant |
95 |
85 |
$2K |
| A5120 |
Skin barrier, wipe or swab |
379 |
300 |
$2K |
| A4424 |
Ost pch drain w bar & filter |
18 |
14 |
$1K |
| A4425 |
Ost pch drain for barrier fl |
28 |
24 |
$988.56 |
| A4217 |
Sterile water/saline, 500 ml |
33 |
26 |
$895.80 |
| B4152 |
Ef calorie dense>/=1.5kcal |
28 |
16 |
$870.92 |
| A6402 |
Sterile gauze <= 16 sq in |
14 |
12 |
$287.38 |
| A4456 |
Adhesive remover, wipes |
36 |
29 |
$241.14 |