| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
3,963 |
3,748 |
$239K |
| A4927 |
Non-sterile gloves |
6,996 |
6,381 |
$196K |
| T4527 |
Adult size pull-on lg |
1,191 |
1,123 |
$139K |
| T4535 |
Disposable liner/shield/pad |
1,915 |
1,772 |
$100K |
| T4528 |
Adult size pull-on xl |
614 |
566 |
$58K |
| A6250 |
Skin seal protect moisturizr |
1,882 |
1,721 |
$50K |
| A4357 |
Bedside drainage bag |
3,837 |
2,750 |
$17K |
| A4245 |
Alcohol wipes per box |
2,104 |
1,869 |
$13K |
| T4526 |
Adult size pull-on med |
142 |
127 |
$11K |
| A4338 |
Indwelling catheter latex |
2,746 |
1,953 |
$10K |
| A4310 |
Insert tray w/o bag/cath |
3,268 |
2,353 |
$10K |
| A4358 |
Urinary leg or abdomen bag |
3,222 |
2,359 |
$9K |
| A4331 |
Extension drainage tubing |
2,193 |
1,937 |
$9K |
| A4216 |
Sterile water/saline, 10 ml |
463 |
361 |
$5K |
| B4150 |
Ef complet w/intact nutrient |
43 |
38 |
$4K |
| A4452 |
Waterproof tape |
980 |
615 |
$4K |
| A6216 |
Non-sterile gauze<=16 sq in |
829 |
508 |
$3K |
| A5120 |
Skin barrier, wipe or swab |
389 |
355 |
$2K |
| A4402 |
Lubricant per ounce |
1,529 |
1,070 |
$2K |
| T4523 |
Adult size brief/diaper lg |
14 |
12 |
$2K |
| A6402 |
Sterile gauze <= 16 sq in |
525 |
372 |
$2K |
| A5114 |
Foam/fabric leg strap |
332 |
274 |
$2K |
| A4553 |
Nondisp underpads, all sizes |
65 |
64 |
$2K |
| A4334 |
Urinary cath leg strap |
600 |
431 |
$661.58 |
| A4456 |
Adhesive remover, wipes |
13 |
12 |
$131.35 |
| A6260 |
Wound cleanser any type/size |
18 |
12 |
$120.48 |