| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
70,697 |
64,068 |
$2.36M |
| T4527 |
Adult size pull-on lg |
22,492 |
20,323 |
$2.23M |
| T4528 |
Adult size pull-on xl |
17,816 |
16,015 |
$1.87M |
| T4526 |
Adult size pull-on med |
21,361 |
19,035 |
$1.70M |
| T4543 |
Adult disp brief/diap abv xl |
10,365 |
9,122 |
$1.56M |
| T4524 |
Adult size brief/diaper xl |
10,711 |
9,836 |
$1.09M |
| T4523 |
Adult size brief/diaper lg |
10,612 |
9,759 |
$1.09M |
| A6250 |
Skin seal protect moisturizr |
136,786 |
125,274 |
$1.08M |
| T4544 |
Adlt disp und/pull on abv xl |
9,416 |
8,440 |
$1.01M |
| T4522 |
Adult size brief/diaper med |
7,915 |
7,119 |
$632K |
| A4927 |
Non-sterile gloves |
32,498 |
28,962 |
$499K |
| A9999 |
Dme supply or accessory, nos |
23,104 |
21,902 |
$490K |
| B4154 |
Ef spec metabolic noninherit |
6,242 |
3,881 |
$455K |
| T4534 |
Youth size pull-on |
5,509 |
4,178 |
$411K |
| B4152 |
Ef calorie dense>/=1.5kcal |
7,394 |
4,868 |
$384K |
| T4525 |
Adult size pull-on sm |
4,094 |
3,662 |
$271K |
| B4150 |
Ef complet w/intact nutrient |
3,486 |
2,133 |
$189K |
| A4351 |
Straight tip urine catheter |
1,208 |
1,028 |
$138K |
| A5120 |
Skin barrier, wipe or swab |
12,884 |
8,737 |
$130K |
| T4533 |
Youth size brief/diaper |
1,594 |
1,266 |
$121K |
| B4035 |
Enteral feed supp pump per d |
14,074 |
8,492 |
$43K |
| B9002 |
Enter nutr inf pump any type |
3,316 |
2,960 |
$42K |
| A4425 |
Ost pch drain for barrier fl |
1,141 |
942 |
$31K |
| B4153 |
Ef hydrolyzed/amino acids |
228 |
162 |
$28K |
| E0776 |
Iv pole |
6,807 |
6,351 |
$26K |
| A4409 |
Ost skn barr convex <=4 sq i |
1,371 |
1,028 |
$25K |
| T4521 |
Adult size brief/diaper sm |
265 |
247 |
$20K |
| A5063 |
Drain ostomy pouch w/flange |
749 |
581 |
$14K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
637 |
548 |
$11K |
| B4034 |
Enter feed supkit syr by day |
3,935 |
3,007 |
$10K |
| A4456 |
Adhesive remover, wipes |
1,354 |
1,122 |
$10K |
| T4530 |
Ped size brief/diaper lg |
125 |
107 |
$9K |
| A4357 |
Bedside drainage bag |
2,228 |
1,978 |
$8K |
| A4338 |
Indwelling catheter latex |
1,513 |
1,369 |
$7K |
| A4629 |
Tracheostomy care kit |
638 |
438 |
$5K |
| A4334 |
Urinary cath leg strap |
307 |
274 |
$2K |
| A4310 |
Insert tray w/o bag/cath |
1,625 |
1,462 |
$2K |
| A4419 |
Ost pch for bar w flange/flt |
142 |
119 |
$2K |
| A6212 |
Foam drg <=16 sq in w/border |
37 |
24 |
$778.32 |
| A6446 |
Conform band s w>=3" <5"/yd |
34 |
30 |
$404.90 |
| A6266 |
Impreg gauze no h20/sal/yard |
14 |
12 |
$307.68 |
| A4406 |
Pectin based ostomy paste |
66 |
51 |
$297.38 |
| A4333 |
Urinary cath anchor device |
25 |
25 |
$264.38 |
| A4320 |
Irrigation tray |
88 |
77 |
$243.70 |
| A4314 |
Cath w/drainage 2-way latex |
26 |
24 |
$238.39 |