| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
3,216 |
2,442 |
$1.48M |
| T4541 |
Large disposable underpad |
36,182 |
34,672 |
$1.27M |
| B4152 |
Ef calorie dense>/=1.5kcal |
7,813 |
6,710 |
$1.05M |
| B4150 |
Ef complet w/intact nutrient |
8,166 |
7,291 |
$936K |
| T4522 |
Adult size brief/diaper med |
10,298 |
9,637 |
$921K |
| T4527 |
Adult size pull-on lg |
10,444 |
10,021 |
$891K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
5,068 |
4,297 |
$887K |
| B4035 |
Enteral feed supp pump per d |
4,974 |
4,379 |
$836K |
| T4523 |
Adult size brief/diaper lg |
8,515 |
7,823 |
$776K |
| T4528 |
Adult size pull-on xl |
7,670 |
7,321 |
$767K |
| T4526 |
Adult size pull-on med |
9,874 |
9,429 |
$755K |
| T4535 |
Disposable liner/shield/pad |
19,125 |
17,654 |
$660K |
| A4927 |
Non-sterile gloves |
46,038 |
42,912 |
$623K |
| B4154 |
Ef spec metabolic noninherit |
3,872 |
3,399 |
$560K |
| B4149 |
Ef blenderized foods |
1,070 |
845 |
$483K |
| T4524 |
Adult size brief/diaper xl |
4,235 |
3,856 |
$415K |
| B4153 |
Ef hydrolyzed/amino acids |
574 |
472 |
$403K |
| B4162 |
Ef ped specmetabolic inherit |
655 |
514 |
$400K |
| T4544 |
Adlt disp und/pull on abv xl |
1,948 |
1,886 |
$376K |
| T4525 |
Adult size pull-on sm |
3,785 |
3,608 |
$284K |
| B9998 |
Enteral supp not otherwise c |
5,169 |
4,158 |
$283K |
| T4537 |
Reusable underpad bed size |
3,996 |
3,826 |
$279K |
| T4534 |
Youth size pull-on |
2,899 |
2,762 |
$205K |
| B4088 |
Gastro/jejuno tube, low-pro |
1,568 |
1,351 |
$151K |
| T4530 |
Ped size brief/diaper lg |
2,401 |
2,216 |
$148K |
| B4155 |
Ef incomplete/modular |
863 |
688 |
$98K |
| B9002 |
Enter nutr inf pump any type |
771 |
722 |
$95K |
| T4543 |
Adult disp brief/diap abv xl |
490 |
438 |
$93K |
| B4034 |
Enter feed supkit syr by day |
760 |
694 |
$66K |
| T4532 |
Ped size pull-on lg |
823 |
779 |
$52K |
| T4521 |
Adult size brief/diaper sm |
605 |
570 |
$45K |
| T4533 |
Youth size brief/diaper |
448 |
428 |
$45K |
| B4100 |
Food thickener oral |
604 |
493 |
$32K |
| T4540 |
Reusable underpad chair size |
408 |
403 |
$22K |
| A4351 |
Straight tip urine catheter |
125 |
110 |
$8K |
| B4158 |
Ef ped complete intact nut |
51 |
39 |
$7K |
| A4322 |
Irrigation syringe |
543 |
481 |
$6K |
| B4036 |
Enteral feed sup kit grav by |
42 |
40 |
$5K |
| T4536 |
Reusable pull-on any size |
35 |
35 |
$4K |
| E0776 |
Iv pole |
61 |
55 |
$4K |
| B4082 |
Enteral ng tubing w/o stylet |
104 |
86 |
$1K |
| A5120 |
Skin barrier, wipe or swab |
58 |
50 |
$405.60 |
| A5063 |
Drain ostomy pouch w/flange |
14 |
12 |
$260.93 |
| A4452 |
Waterproof tape |
13 |
12 |
$216.32 |
| A6402 |
Sterile gauze <= 16 sq in |
13 |
12 |
$94.94 |