| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4534 |
Youth size pull-on |
15,905 |
14,709 |
$1.25M |
| A6197 |
Alginate drsg >16 <=48 sq in |
5,043 |
4,510 |
$1.10M |
| T4528 |
Adult size pull-on xl |
7,269 |
6,714 |
$631K |
| T4541 |
Large disposable underpad |
20,750 |
19,122 |
$543K |
| T4527 |
Adult size pull-on lg |
6,730 |
6,223 |
$540K |
| T4535 |
Disposable liner/shield/pad |
12,346 |
11,302 |
$463K |
| T4526 |
Adult size pull-on med |
6,461 |
5,989 |
$456K |
| A4351 |
Straight tip urine catheter |
3,510 |
3,197 |
$385K |
| A6196 |
Alginate dressing <=16 sq in |
3,835 |
3,461 |
$379K |
| T4530 |
Ped size brief/diaper lg |
5,581 |
5,174 |
$339K |
| A4385 |
Ost skn barrier sld ext wear |
10,311 |
9,431 |
$329K |
| A6021 |
Collagen dressing <=16 sq in |
2,199 |
1,946 |
$273K |
| A4362 |
Solid skin barrier |
7,157 |
6,575 |
$272K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
5,920 |
5,376 |
$263K |
| A6212 |
Foam drg <=16 sq in w/border |
3,748 |
3,339 |
$221K |
| A4353 |
Intermittent urinary cath |
905 |
752 |
$217K |
| A4407 |
Ext wear ost skn barr <=4sq" |
3,797 |
3,460 |
$212K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
3,585 |
3,321 |
$177K |
| A4352 |
Coude tip urinary catheter |
765 |
687 |
$168K |
| T4522 |
Adult size brief/diaper med |
1,997 |
1,859 |
$166K |
| T4525 |
Adult size pull-on sm |
1,902 |
1,773 |
$141K |
| A5063 |
Drain ostomy pouch w/flange |
6,364 |
5,848 |
$140K |
| T4532 |
Ped size pull-on lg |
1,837 |
1,717 |
$134K |
| A4389 |
Drainable pch w st wear barr |
1,684 |
1,558 |
$134K |
| A4927 |
Non-sterile gloves |
15,684 |
14,446 |
$133K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
1,513 |
1,385 |
$127K |
| A4409 |
Ost skn barr convex <=4 sq i |
2,912 |
2,680 |
$123K |
| A6446 |
Conform band s w>=3" <5"/yd |
5,772 |
5,246 |
$111K |
| A4373 |
Skin barrier with flange |
1,716 |
1,553 |
$111K |
| T4523 |
Adult size brief/diaper lg |
1,202 |
1,127 |
$104K |
| A5121 |
Solid skin barrier 6x6 |
1,925 |
1,805 |
$97K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
1,050 |
930 |
$96K |
| E0603 |
Electric breast pump |
633 |
608 |
$81K |
| A4452 |
Waterproof tape |
4,537 |
4,107 |
$80K |
| T4543 |
Adult disp brief/diap abv xl |
525 |
476 |
$80K |
| T4524 |
Adult size brief/diaper xl |
797 |
736 |
$78K |
| A5057 |
1 pc ost pou w built-in conv |
1,441 |
1,310 |
$77K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
517 |
367 |
$76K |
| T4537 |
Reusable underpad bed size |
5,236 |
4,872 |
$73K |
| A5061 |
Pouch drainable w barrier at |
1,565 |
1,428 |
$66K |
| A4388 |
Drainable pch w ex wear barr |
1,500 |
1,395 |
$66K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
705 |
626 |
$60K |
| A5120 |
Skin barrier, wipe or swab |
10,525 |
9,698 |
$50K |
| A6266 |
Impreg gauze no h20/sal/yard |
781 |
714 |
$44K |
| A4425 |
Ost pch drain for barrier fl |
2,716 |
2,483 |
$44K |
| A4406 |
Pectin based ostomy paste |
5,102 |
4,735 |
$40K |
| A4390 |
Drainable pch ex wear convex |
614 |
575 |
$40K |
| A6402 |
Sterile gauze <= 16 sq in |
5,712 |
5,233 |
$39K |
| A4393 |
Urine pch w ex wear bar conv |
548 |
500 |
$36K |
| A5054 |
Clsd ostomy pouch w/flange |
1,015 |
908 |
$36K |
| A6199 |
Alginate drsg wound filler |
705 |
627 |
$35K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
1,231 |
1,111 |
$33K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
783 |
682 |
$31K |
| A5056 |
1 pc ost pouch w filter |
1,037 |
956 |
$31K |
| A6449 |
Lt compres band >=3" <5"/yd |
1,930 |
1,677 |
$27K |
| A4419 |
Ost pch for bar w flange/flt |
869 |
816 |
$27K |
| A6216 |
Non-sterile gauze<=16 sq in |
4,803 |
4,065 |
$26K |
| A4410 |
Ost skn barr extnd >4 sq |
683 |
619 |
$26K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
930 |
854 |
$25K |
| A4371 |
Skin barrier powder per oz |
5,743 |
5,345 |
$24K |
| A4450 |
Non-waterproof tape |
6,154 |
5,674 |
$23K |
| A4357 |
Bedside drainage bag |
3,583 |
3,296 |
$22K |
| A5073 |
Urinary pouch on barr w/flng |
642 |
597 |
$17K |
| A6219 |
Gauze <= 16 sq in w/border |
961 |
893 |
$16K |
| A4349 |
Disposable male external cat |
481 |
426 |
$16K |
| A6217 |
Non-sterile gauze>16<=48 sq |
618 |
565 |
$13K |
| A6258 |
Transparent film >16<=48 in |
485 |
440 |
$12K |
| A4367 |
Ostomy belt |
4,201 |
3,889 |
$11K |
| A4216 |
Sterile water/saline, 10 ml |
1,175 |
1,086 |
$11K |
| A6240 |
Hydrocolld drg filler paste |
413 |
381 |
$10K |
| A4217 |
Sterile water/saline, 500 ml |
1,633 |
1,505 |
$10K |
| A4427 |
Ost pch drain/barr lk flng/f |
500 |
444 |
$9K |
| T4521 |
Adult size brief/diaper sm |
114 |
105 |
$9K |
| A4358 |
Urinary leg or abdomen bag |
1,453 |
1,267 |
$9K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
204 |
182 |
$7K |
| A4402 |
Lubricant per ounce |
1,986 |
1,816 |
$7K |
| A4314 |
Cath w/drainage 2-way latex |
425 |
395 |
$6K |
| A6443 |
Conform band n/s w>=3"<5"/yd |
664 |
614 |
$6K |
| T4544 |
Adlt disp und/pull on abv xl |
27 |
27 |
$6K |
| A4369 |
Skin barrier liquid per oz |
1,443 |
1,342 |
$6K |
| A4392 |
Urinary pouch w st wear barr |
84 |
77 |
$6K |
| A4405 |
Nonpectin based ostomy paste |
715 |
653 |
$6K |
| A6454 |
Self-adher band w>=3" <5"/yd |
617 |
552 |
$5K |
| A4394 |
Ostomy pouch liq deodorant |
828 |
773 |
$5K |
| A4455 |
Adhesive remover per ounce |
1,443 |
1,359 |
$5K |
| T4531 |
Ped size pull-on sm/med |
53 |
51 |
$4K |
| A4432 |
Os pch urine w bar/fange/tap |
496 |
452 |
$4K |
| A4320 |
Irrigation tray |
402 |
362 |
$3K |
| A6248 |
Hydrogel drsg gel filler |
157 |
144 |
$3K |
| A4333 |
Urinary cath anchor device |
432 |
398 |
$3K |
| A4396 |
Peristomal hernia supprt blt |
266 |
243 |
$3K |
| A4344 |
Cath indw foley 2 way silicn |
377 |
321 |
$3K |
| A4338 |
Indwelling catheter latex |
987 |
854 |
$2K |
| A4322 |
Irrigation syringe |
523 |
458 |
$2K |
| A4930 |
Sterile, gloves per pair |
116 |
101 |
$2K |
| A6220 |
Gauze >16 <=48 sq in w/bordr |
68 |
57 |
$2K |
| A4335 |
Incontinence supply |
971 |
856 |
$2K |
| A4230 |
Infus insulin pump non needl |
13 |
13 |
$2K |
| A4456 |
Adhesive remover, wipes |
2,324 |
2,151 |
$2K |
| A4670 |
Automatic bp monitor, dial |
54 |
54 |
$2K |
| A4310 |
Insert tray w/o bag/cath |
1,140 |
987 |
$1K |
| A4247 |
Betadine/iodine swabs/wipes |
111 |
84 |
$1K |
| B4036 |
Enteral feed sup kit grav by |
88 |
80 |
$1K |
| A4232 |
Syringe w/needle insulin 3cc |
42 |
39 |
$1K |
| A4424 |
Ost pch drain w bar & filter |
69 |
65 |
$1K |
| A6450 |
Lt compres band >=5"/yd |
105 |
97 |
$1K |
| A4413 |
2 pc drainable ost pouch |
87 |
80 |
$1K |
| A4239 |
Non-adju cgm supply allow |
218 |
187 |
$878.50 |
| B4150 |
Ef complet w/intact nutrient |
38 |
24 |
$735.13 |
| A6452 |
High compres band w>=3"<5"yd |
26 |
25 |
$566.57 |
| A6218 |
Non-sterile gauze > 48 sq in |
58 |
53 |
$520.44 |
| A4411 |
Ost skn barr extnd =4sq |
12 |
12 |
$318.58 |
| A6441 |
Pad band w>=3" <5"/yd |
41 |
39 |
$256.17 |
| A6442 |
Conform band n/s w<3"/yd |
31 |
30 |
$210.37 |
| A6403 |
Sterile gauze>16 <= 48 sq in |
14 |
13 |
$154.82 |
| A4311 |
Catheter w/o bag 2-way latex |
16 |
15 |
$114.79 |
| A4331 |
Extension drainage tubing |
26 |
25 |
$30.71 |
| A4334 |
Urinary cath leg strap |
15 |
12 |
$22.50 |