| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0603 |
Electric breast pump |
5,852 |
5,320 |
$569K |
| A4385 |
Ost skn barrier sld ext wear |
775 |
601 |
$42K |
| A4409 |
Ost skn barr convex <=4 sq i |
596 |
457 |
$39K |
| A4230 |
Infus insulin pump non needl |
223 |
194 |
$23K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
115 |
107 |
$22K |
| A5063 |
Drain ostomy pouch w/flange |
367 |
282 |
$11K |
| A4425 |
Ost pch drain for barrier fl |
285 |
222 |
$11K |
| A4394 |
Ostomy pouch liq deodorant |
392 |
313 |
$9K |
| A4362 |
Solid skin barrier |
304 |
242 |
$9K |
| A4225 |
Sup/ext insulin inf pump syr |
225 |
193 |
$7K |
| A4406 |
Pectin based ostomy paste |
351 |
292 |
$5K |
| A4456 |
Adhesive remover, wipes |
906 |
695 |
$4K |
| A5120 |
Skin barrier, wipe or swab |
703 |
536 |
$3K |
| A4253 |
Blood glucose/reagent strips |
118 |
101 |
$2K |
| A4371 |
Skin barrier powder per oz |
363 |
301 |
$1K |
| A4455 |
Adhesive remover per ounce |
82 |
69 |
$281.85 |
| A4287 |
Disp col sto bag breast milk |
13 |
13 |
$263.55 |
| A4927 |
Non-sterile gloves |
26 |
25 |
$180.75 |
| A4259 |
Lancets per box |
13 |
12 |
$51.73 |