| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4160 |
Ef ped caloric dense>/=0.7kc |
2,546 |
2,449 |
$1.48M |
| B4035 |
Enteral feed supp pump per d |
5,285 |
5,193 |
$1.40M |
| B4161 |
Ef ped hydrolyzed/amino acid |
1,373 |
1,290 |
$1.30M |
| T4534 |
Youth size pull-on |
5,670 |
5,588 |
$1.03M |
| A4554 |
Disposable underpads |
13,741 |
13,610 |
$840K |
| B4149 |
Ef blenderized foods |
2,334 |
2,218 |
$796K |
| B9998 |
Enteral supp not otherwise c |
6,470 |
5,464 |
$700K |
| A4927 |
Non-sterile gloves |
23,385 |
22,996 |
$694K |
| B4088 |
Gastro/jejuno tube, low-pro |
5,014 |
4,370 |
$661K |
| T4523 |
Adult size brief/diaper lg |
4,526 |
4,449 |
$609K |
| T4526 |
Adult size pull-on med |
4,309 |
4,245 |
$556K |
| T4522 |
Adult size brief/diaper med |
4,434 |
4,356 |
$555K |
| T4535 |
Disposable liner/shield/pad |
9,708 |
9,575 |
$507K |
| T4527 |
Adult size pull-on lg |
3,126 |
3,087 |
$484K |
| B4153 |
Ef hydrolyzed/amino acids |
671 |
631 |
$427K |
| T4521 |
Adult size brief/diaper sm |
2,900 |
2,848 |
$347K |
| B4150 |
Ef complet w/intact nutrient |
2,714 |
2,590 |
$343K |
| T4528 |
Adult size pull-on xl |
2,279 |
2,242 |
$306K |
| T4533 |
Youth size brief/diaper |
2,171 |
2,145 |
$251K |
| B4155 |
Ef incomplete/modular |
786 |
760 |
$222K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,177 |
1,130 |
$211K |
| A6250 |
Skin seal protect moisturizr |
10,991 |
10,788 |
$199K |
| T4524 |
Adult size brief/diaper xl |
943 |
918 |
$125K |
| A9286 |
Any hygienic item, device |
3,382 |
3,351 |
$124K |
| T4525 |
Adult size pull-on sm |
1,021 |
1,010 |
$104K |
| B4104 |
Additive for enteral formula |
935 |
735 |
$71K |
| A6402 |
Sterile gauze <= 16 sq in |
3,223 |
3,149 |
$67K |
| A4213 |
20+ cc syringe only |
1,301 |
1,284 |
$64K |
| B4034 |
Enter feed supkit syr by day |
427 |
424 |
$58K |
| A4553 |
Nondisp underpads, all sizes |
1,135 |
1,101 |
$38K |
| A4209 |
5+ cc sterile syringe&needle |
3,323 |
3,272 |
$29K |
| A9901 |
Delivery/set up/dispensing |
1,069 |
508 |
$16K |
| B4100 |
Food thickener oral |
144 |
89 |
$12K |
| A4452 |
Waterproof tape |
947 |
934 |
$10K |
| T5999 |
Supply, nos |
1,564 |
1,407 |
$8K |
| A4338 |
Indwelling catheter latex |
104 |
100 |
$7K |
| A4332 |
Lube sterile packet |
869 |
861 |
$7K |
| T4530 |
Ped size brief/diaper lg |
59 |
52 |
$5K |
| B4036 |
Enteral feed sup kit grav by |
13 |
13 |
$1K |
| A4351 |
Straight tip urine catheter |
13 |
12 |
$1K |
| B9002 |
Enter nutr inf pump any type |
64 |
62 |
$1K |
| A4245 |
Alcohol wipes per box |
100 |
100 |
$1K |
| A4208 |
3 cc sterile syringe&needle |
78 |
76 |
$337.14 |
| S8301 |
Infect control supplies nos |
24 |
24 |
$322.64 |
| A4244 |
Alcohol or peroxide per pint |
404 |
400 |
$216.35 |