| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4534 |
Youth size pull-on |
6,864 |
6,754 |
$1.31M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
2,921 |
2,086 |
$488K |
| T4533 |
Youth size brief/diaper |
3,688 |
3,588 |
$423K |
| T4522 |
Adult size brief/diaper med |
2,190 |
2,144 |
$268K |
| B4161 |
Ef ped hydrolyzed/amino acid |
371 |
363 |
$253K |
| T4526 |
Adult size pull-on med |
1,362 |
1,343 |
$229K |
| B4150 |
Ef complet w/intact nutrient |
2,185 |
1,400 |
$219K |
| B4035 |
Enteral feed supp pump per d |
939 |
918 |
$209K |
| B4155 |
Ef incomplete/modular |
509 |
493 |
$171K |
| B9998 |
Enteral supp not otherwise c |
2,120 |
1,577 |
$158K |
| T4527 |
Adult size pull-on lg |
162 |
162 |
$32K |
| B4152 |
Ef calorie dense>/=1.5kcal |
310 |
187 |
$31K |
| T4535 |
Disposable liner/shield/pad |
739 |
716 |
$25K |
| T4523 |
Adult size brief/diaper lg |
123 |
120 |
$23K |
| A4351 |
Straight tip urine catheter |
60 |
60 |
$7K |
| A7000 |
Disposable canister for pump |
84 |
84 |
$2K |
| A4322 |
Irrigation syringe |
26 |
26 |
$888.36 |
| A7002 |
Tubing used w suction pump |
84 |
84 |
$758.67 |
| A4628 |
Oropharyngeal suction cath |
109 |
108 |
$600.24 |
| A6402 |
Sterile gauze <= 16 sq in |
12 |
12 |
$298.00 |