| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4150 |
Ef complet w/intact nutrient |
16,903 |
16,483 |
$1.95M |
| T4526 |
Adult size pull-on med |
17,623 |
17,478 |
$1.53M |
| T4527 |
Adult size pull-on lg |
15,082 |
14,936 |
$1.37M |
| B4154 |
Ef spec metabolic noninherit |
13,037 |
12,572 |
$995K |
| T4528 |
Adult size pull-on xl |
8,910 |
8,843 |
$964K |
| T4523 |
Adult size brief/diaper lg |
8,344 |
8,245 |
$862K |
| T4541 |
Large disposable underpad |
25,011 |
24,852 |
$848K |
| A4927 |
Non-sterile gloves |
26,180 |
25,908 |
$642K |
| B4152 |
Ef calorie dense>/=1.5kcal |
4,345 |
4,179 |
$517K |
| T4535 |
Disposable liner/shield/pad |
11,823 |
11,661 |
$513K |
| T4524 |
Adult size brief/diaper xl |
3,916 |
3,880 |
$464K |
| T4522 |
Adult size brief/diaper med |
4,711 |
4,636 |
$380K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
3,200 |
3,138 |
$374K |
| E0570 |
Nebulizer with compression |
4,689 |
4,647 |
$361K |
| A4351 |
Straight tip urine catheter |
2,697 |
2,506 |
$343K |
| T4525 |
Adult size pull-on sm |
3,122 |
3,086 |
$328K |
| T4534 |
Youth size pull-on |
2,112 |
2,094 |
$320K |
| A4353 |
Intermittent urinary cath |
568 |
552 |
$277K |
| A4670 |
Automatic bp monitor, dial |
4,325 |
4,301 |
$242K |
| T4530 |
Ped size brief/diaper lg |
1,393 |
1,384 |
$174K |
| T4544 |
Adlt disp und/pull on abv xl |
754 |
736 |
$161K |
| T4537 |
Reusable underpad bed size |
8,922 |
8,889 |
$145K |
| E0245 |
Tub stool or bench |
3,423 |
3,406 |
$137K |
| K0001 |
Standard wheelchair |
4,014 |
3,933 |
$131K |
| A6530 |
Compression stocking bk18-30 |
1,151 |
1,049 |
$107K |
| A4349 |
Disposable male external cat |
1,879 |
1,661 |
$102K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,708 |
1,684 |
$91K |
| B4100 |
Food thickener oral |
1,825 |
1,788 |
$79K |
| L3908 |
Who cock-up nonmolde pre ots |
1,197 |
1,103 |
$69K |
| E0143 |
Walker folding wheeled w/o s |
1,985 |
1,927 |
$68K |
| T4543 |
Adult disp brief/diap abv xl |
314 |
307 |
$63K |
| A7005 |
Nondisposable nebulizer set |
2,554 |
2,533 |
$50K |
| A9901 |
Delivery/set up/dispensing |
15,536 |
15,356 |
$43K |
| T4532 |
Ped size pull-on lg |
147 |
147 |
$23K |
| B4102 |
Ef adult fluids and electro |
264 |
252 |
$23K |
| E0163 |
Commode chair with fixed arm |
487 |
479 |
$21K |
| A4357 |
Bedside drainage bag |
3,116 |
2,973 |
$20K |
| E0100 |
Cane adjust/fixed with tip |
1,734 |
1,720 |
$18K |
| A4358 |
Urinary leg or abdomen bag |
2,196 |
2,064 |
$14K |
| E0244 |
Toilet seat raised |
280 |
279 |
$13K |
| K0003 |
Lightweight wheelchair |
163 |
161 |
$12K |
| A6402 |
Sterile gauze <= 16 sq in |
760 |
693 |
$9K |
| E0105 |
Cane adjust/fixed quad/3 pro |
373 |
371 |
$8K |
| E0156 |
Walker seat attachment |
884 |
873 |
$7K |
| E0241 |
Bath tub wall rail |
233 |
220 |
$7K |
| T4521 |
Adult size brief/diaper sm |
89 |
89 |
$7K |
| E1038 |
Transport chair pt wt<=300lb |
715 |
707 |
$7K |
| L4387 |
Non-pneum walk boot pre ots |
52 |
52 |
$6K |
| A4402 |
Lubricant per ounce |
1,020 |
947 |
$5K |
| A7015 |
Aerosol mask used w nebulize |
2,779 |
2,765 |
$4K |
| A7013 |
Disposable compressor filter |
2,123 |
2,074 |
$4K |
| E0247 |
Trans bench w/wo comm open |
45 |
44 |
$3K |
| A6533 |
Gc stocking thighlngth 18-30 |
16 |
12 |
$2K |
| V2020 |
Vision svcs frames purchases |
20 |
20 |
$2K |
| A4217 |
Sterile water/saline, 500 ml |
96 |
94 |
$2K |
| A5063 |
Drain ostomy pouch w/flange |
104 |
88 |
$2K |
| L0625 |
Lo flex l1-below l5 pre ots |
51 |
50 |
$1K |
| L1812 |
Ko elastic w/joints pre ots |
27 |
27 |
$1K |
| E0114 |
Crutch underarm pair no wood |
25 |
25 |
$904.37 |
| A4409 |
Ost skn barr convex <=4 sq i |
12 |
12 |
$765.80 |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
40 |
37 |
$759.49 |
| A4322 |
Irrigation syringe |
184 |
182 |
$752.29 |
| A4450 |
Non-waterproof tape |
180 |
179 |
$738.16 |
| A5120 |
Skin barrier, wipe or swab |
91 |
90 |
$721.22 |
| 92014 |
|
12 |
12 |
$703.80 |
| A7003 |
Nebulizer administration set |
397 |
396 |
$635.56 |
| A4245 |
Alcohol wipes per box |
94 |
88 |
$454.18 |
| A4335 |
Incontinence supply |
77 |
62 |
$429.20 |
| E2601 |
Gen w/c cushion wdth < 22 in |
14 |
14 |
$413.23 |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
12 |
12 |
$359.80 |
| A4338 |
Indwelling catheter latex |
39 |
36 |
$329.70 |
| 92015 |
|
14 |
14 |
$197.40 |
| A4310 |
Insert tray w/o bag/cath |
12 |
12 |
$65.39 |
| 90662 |
|
29 |
29 |
$0.00 |
| 90756 |
|
85 |
85 |
$0.00 |
| G0008 |
Admin influenza virus vac |
359 |
359 |
$0.00 |
| 90688 |
|
21 |
21 |
$0.00 |
| 90674 |
|
106 |
106 |
$0.00 |
| 90686 |
|
71 |
71 |
$0.00 |