| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4351 |
Straight tip urine catheter |
1,884 |
1,715 |
$450K |
| L4361 |
Pneuma/vac walk boot pre ots |
1,096 |
1,054 |
$270K |
| A4385 |
Ost skn barrier sld ext wear |
3,748 |
3,396 |
$268K |
| E0603 |
Electric breast pump |
858 |
830 |
$204K |
| S5161 |
Emer rspns sys serv permonth |
8,521 |
7,203 |
$198K |
| A4407 |
Ext wear ost skn barr <=4sq" |
982 |
910 |
$137K |
| A7030 |
Cpap full face mask |
1,429 |
1,371 |
$134K |
| A4352 |
Coude tip urinary catheter |
153 |
144 |
$129K |
| A7031 |
Replacement facemask interfa |
2,061 |
2,000 |
$80K |
| A4604 |
Tubing with heating element |
1,902 |
1,842 |
$76K |
| A4409 |
Ost skn barr convex <=4 sq i |
627 |
572 |
$72K |
| E0114 |
Crutch underarm pair no wood |
1,087 |
1,037 |
$57K |
| E0143 |
Walker folding wheeled w/o s |
1,033 |
982 |
$53K |
| L3908 |
Who cock-up nonmolde pre ots |
934 |
870 |
$47K |
| A5057 |
1 pc ost pou w built-in conv |
299 |
291 |
$44K |
| A5063 |
Drain ostomy pouch w/flange |
855 |
782 |
$40K |
| L3809 |
Whfo w/o joints pre ots |
322 |
299 |
$37K |
| A7035 |
Pos airway press headgear |
1,834 |
1,757 |
$36K |
| A4362 |
Solid skin barrier |
722 |
671 |
$34K |
| A7038 |
Pos airway pressure filter |
7,334 |
7,023 |
$33K |
| T4528 |
Adult size pull-on xl |
264 |
251 |
$31K |
| A4357 |
Bedside drainage bag |
1,494 |
1,425 |
$30K |
| E0570 |
Nebulizer with compression |
856 |
816 |
$28K |
| A6212 |
Foam drg <=16 sq in w/border |
98 |
87 |
$28K |
| A7034 |
Nasal application device |
484 |
449 |
$26K |
| A4432 |
Os pch urine w bar/fange/tap |
378 |
358 |
$22K |
| A4425 |
Ost pch drain for barrier fl |
321 |
299 |
$20K |
| E0604 |
Hosp grade elec breast pump |
309 |
278 |
$19K |
| A4927 |
Non-sterile gloves |
657 |
619 |
$19K |
| A4419 |
Ost pch for bar w flange/flt |
193 |
172 |
$17K |
| A4456 |
Adhesive remover, wipes |
1,601 |
1,515 |
$15K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
232 |
211 |
$14K |
| A7032 |
Replacement nasal cushion |
399 |
371 |
$14K |
| A4394 |
Ostomy pouch liq deodorant |
564 |
512 |
$12K |
| A7037 |
Pos airway pressure tubing |
742 |
697 |
$12K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
57 |
53 |
$11K |
| A7046 |
Repl water chamber, pap dev |
949 |
907 |
$11K |
| A4467 |
Belt strap sleev grmnt cover |
186 |
163 |
$10K |
| A4452 |
Waterproof tape |
389 |
354 |
$9K |
| A6530 |
Compression stocking bk18-30 |
120 |
111 |
$9K |
| A6402 |
Sterile gauze <= 16 sq in |
765 |
668 |
$8K |
| T4541 |
Large disposable underpad |
206 |
172 |
$7K |
| A4402 |
Lubricant per ounce |
681 |
640 |
$7K |
| A4358 |
Urinary leg or abdomen bag |
561 |
524 |
$6K |
| A4216 |
Sterile water/saline, 10 ml |
182 |
173 |
$4K |
| A4627 |
Spacer bag/reservoir |
162 |
159 |
$4K |
| T4527 |
Adult size pull-on lg |
50 |
48 |
$4K |
| E0118 |
Crutch substitute |
57 |
55 |
$3K |
| A4367 |
Ostomy belt |
443 |
431 |
$3K |
| L4350 |
Ankle control ortho pre ots |
28 |
28 |
$3K |
| A6216 |
Non-sterile gauze<=16 sq in |
303 |
282 |
$3K |
| A4371 |
Skin barrier powder per oz |
656 |
612 |
$3K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
62 |
54 |
$2K |
| A4411 |
Ost skn barr extnd =4sq |
25 |
25 |
$2K |
| A7033 |
Replacement nasal pillows |
86 |
81 |
$2K |
| A4369 |
Skin barrier liquid per oz |
559 |
544 |
$2K |
| A6443 |
Conform band n/s w>=3"<5"/yd |
104 |
94 |
$2K |
| A4213 |
20+ cc syringe only |
107 |
102 |
$2K |
| A4333 |
Urinary cath anchor device |
70 |
66 |
$2K |
| A6449 |
Lt compres band >=3" <5"/yd |
125 |
120 |
$1K |
| L1902 |
Afo ankle gauntlet pre ots |
12 |
12 |
$923.50 |
| A4670 |
Automatic bp monitor, dial |
14 |
13 |
$901.82 |
| A5120 |
Skin barrier, wipe or swab |
124 |
122 |
$817.90 |
| E1399 |
Durable medical equipment mi |
13 |
12 |
$773.09 |
| A4310 |
Insert tray w/o bag/cath |
12 |
12 |
$455.87 |
| A4455 |
Adhesive remover per ounce |
28 |
24 |
$58.76 |
| E0601 |
Cont airway pressure device |
66 |
61 |
$0.00 |