| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
70,032 |
53,383 |
$2.66M |
| T4527 |
Adult size pull-on lg |
28,142 |
22,550 |
$2.33M |
| T4526 |
Adult size pull-on med |
24,964 |
19,679 |
$1.90M |
| T4528 |
Adult size pull-on xl |
20,761 |
15,541 |
$1.61M |
| T4544 |
Adlt disp und/pull on abv xl |
10,857 |
7,545 |
$1.19M |
| T4522 |
Adult size brief/diaper med |
8,064 |
6,810 |
$813K |
| T4534 |
Youth size pull-on |
6,242 |
5,385 |
$622K |
| A4253 |
Blood glucose/reagent strips |
14,716 |
8,890 |
$601K |
| T4523 |
Adult size brief/diaper lg |
5,600 |
4,470 |
$539K |
| T4525 |
Adult size pull-on sm |
6,969 |
5,364 |
$534K |
| A4927 |
Non-sterile gloves |
41,564 |
31,179 |
$524K |
| T4532 |
Ped size pull-on lg |
3,996 |
3,141 |
$383K |
| T4530 |
Ped size brief/diaper lg |
3,442 |
2,891 |
$260K |
| T4521 |
Adult size brief/diaper sm |
2,555 |
2,171 |
$250K |
| T4524 |
Adult size brief/diaper xl |
2,168 |
1,718 |
$203K |
| A4335 |
Incontinence supply |
41,349 |
27,783 |
$195K |
| T4543 |
Adult disp brief/diap abv xl |
1,813 |
1,091 |
$164K |
| A4670 |
Automatic bp monitor, dial |
4,873 |
2,643 |
$148K |
| A4259 |
Lancets per box |
14,126 |
8,674 |
$138K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
777 |
604 |
$96K |
| E0607 |
Blood glucose monitor home |
1,853 |
939 |
$53K |
| A4256 |
Calibrator solution/chips |
5,553 |
3,465 |
$35K |
| E0445 |
Oximeter non-invasive |
708 |
354 |
$25K |
| A4258 |
Lancet device each |
2,743 |
1,538 |
$23K |
| E1639 |
Scale, each |
602 |
352 |
$21K |
| A6402 |
Sterile gauze <= 16 sq in |
1,332 |
768 |
$13K |
| A4353 |
Intermittent urinary cath |
12 |
12 |
$13K |
| A4409 |
Ost skn barr convex <=4 sq i |
125 |
117 |
$10K |
| A4385 |
Ost skn barrier sld ext wear |
175 |
136 |
$9K |
| A6259 |
Transparent film > 48 sq in |
105 |
85 |
$8K |
| T4533 |
Youth size brief/diaper |
94 |
65 |
$7K |
| A4357 |
Bedside drainage bag |
914 |
508 |
$7K |
| A5063 |
Drain ostomy pouch w/flange |
217 |
179 |
$6K |
| A4351 |
Straight tip urine catheter |
37 |
36 |
$5K |
| A4349 |
Disposable male external cat |
103 |
81 |
$4K |
| A4456 |
Adhesive remover, wipes |
552 |
426 |
$4K |
| A4406 |
Pectin based ostomy paste |
250 |
212 |
$3K |
| A4358 |
Urinary leg or abdomen bag |
339 |
222 |
$2K |
| A4362 |
Solid skin barrier |
75 |
66 |
$2K |
| A5120 |
Skin barrier, wipe or swab |
284 |
149 |
$1K |
| A4425 |
Ost pch drain for barrier fl |
35 |
24 |
$991.62 |
| A4371 |
Skin barrier powder per oz |
109 |
102 |
$589.17 |
| A4394 |
Ostomy pouch liq deodorant |
13 |
12 |
$280.00 |