| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4534 |
Youth size pull-on |
3,207 |
3,056 |
$431K |
| A4554 |
Disposable underpads |
11,658 |
11,297 |
$427K |
| T4526 |
Adult size pull-on med |
4,168 |
4,044 |
$358K |
| T4527 |
Adult size pull-on lg |
3,753 |
3,659 |
$303K |
| A9900 |
Supply/accessory/service |
6,218 |
4,924 |
$287K |
| B9998 |
Enteral supp not otherwise c |
1,240 |
1,003 |
$242K |
| A4927 |
Non-sterile gloves |
21,536 |
19,403 |
$233K |
| T4522 |
Adult size brief/diaper med |
2,091 |
2,026 |
$212K |
| T4528 |
Adult size pull-on xl |
2,501 |
2,403 |
$203K |
| T4530 |
Ped size brief/diaper lg |
1,775 |
1,704 |
$197K |
| T4523 |
Adult size brief/diaper lg |
1,561 |
1,508 |
$145K |
| B4150 |
Ef complet w/intact nutrient |
866 |
816 |
$142K |
| B4035 |
Enteral feed supp pump per d |
608 |
586 |
$115K |
| A4335 |
Incontinence supply |
1,703 |
1,502 |
$109K |
| T4532 |
Ped size pull-on lg |
824 |
808 |
$106K |
| A4245 |
Alcohol wipes per box |
8,305 |
8,055 |
$106K |
| T4521 |
Adult size brief/diaper sm |
773 |
755 |
$79K |
| T4524 |
Adult size brief/diaper xl |
749 |
730 |
$78K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
335 |
326 |
$70K |
| B4034 |
Enter feed supkit syr by day |
682 |
607 |
$66K |
| T4535 |
Disposable liner/shield/pad |
1,100 |
1,066 |
$54K |
| B9002 |
Enter nutr inf pump any type |
733 |
723 |
$50K |
| B4152 |
Ef calorie dense>/=1.5kcal |
221 |
211 |
$46K |
| B4088 |
Gastro/jejuno tube, low-pro |
564 |
423 |
$45K |
| S5199 |
Personal care item nos each |
2,448 |
2,231 |
$34K |
| A4322 |
Irrigation syringe |
360 |
332 |
$24K |
| T4525 |
Adult size pull-on sm |
103 |
101 |
$10K |
| E0630 |
Patient lift hydraulic |
500 |
376 |
$10K |
| E0260 |
Hosp bed semi-electr w/ matt |
506 |
394 |
$7K |
| A4351 |
Straight tip urine catheter |
43 |
38 |
$5K |
| K0001 |
Standard wheelchair |
479 |
347 |
$4K |
| K0195 |
Elevating whlchair leg rests |
850 |
573 |
$4K |
| K0003 |
Lightweight wheelchair |
150 |
103 |
$3K |
| A4213 |
20+ cc syringe only |
66 |
63 |
$2K |
| A6402 |
Sterile gauze <= 16 sq in |
109 |
103 |
$703.15 |
| A4349 |
Disposable male external cat |
31 |
24 |
$686.40 |
| A4357 |
Bedside drainage bag |
87 |
73 |
$351.46 |
| A4402 |
Lubricant per ounce |
15 |
14 |
$24.46 |