| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4150 |
Ef complet w/intact nutrient |
3,500 |
3,449 |
$395K |
| T4541 |
Large disposable underpad |
3,917 |
3,883 |
$293K |
| T4527 |
Adult size pull-on lg |
2,026 |
2,002 |
$267K |
| T4526 |
Adult size pull-on med |
2,136 |
2,115 |
$240K |
| T4534 |
Youth size pull-on |
1,780 |
1,741 |
$211K |
| T4528 |
Adult size pull-on xl |
1,372 |
1,347 |
$183K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,009 |
977 |
$157K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,088 |
1,073 |
$154K |
| B4154 |
Ef spec metabolic noninherit |
906 |
888 |
$141K |
| A4927 |
Non-sterile gloves |
4,610 |
4,536 |
$114K |
| B4161 |
Ef ped hydrolyzed/amino acid |
324 |
320 |
$100K |
| T4522 |
Adult size brief/diaper med |
667 |
660 |
$97K |
| T4535 |
Disposable liner/shield/pad |
3,740 |
3,656 |
$86K |
| A4351 |
Straight tip urine catheter |
399 |
390 |
$68K |
| B4035 |
Enteral feed supp pump per d |
194 |
186 |
$66K |
| T4523 |
Adult size brief/diaper lg |
413 |
402 |
$56K |
| T4530 |
Ped size brief/diaper lg |
349 |
342 |
$50K |
| T4524 |
Adult size brief/diaper xl |
244 |
240 |
$31K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
64 |
64 |
$9K |
| A4554 |
Disposable underpads |
239 |
231 |
$7K |
| A4385 |
Ost skn barrier sld ext wear |
79 |
78 |
$4K |
| A4357 |
Bedside drainage bag |
376 |
346 |
$3K |
| A6530 |
Compression stocking bk18-30 |
30 |
30 |
$3K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
28 |
28 |
$2K |
| T4525 |
Adult size pull-on sm |
12 |
12 |
$1K |
| A4358 |
Urinary leg or abdomen bag |
161 |
155 |
$1K |
| A6402 |
Sterile gauze <= 16 sq in |
128 |
123 |
$1K |
| A5063 |
Drain ostomy pouch w/flange |
26 |
25 |
$1K |
| A4402 |
Lubricant per ounce |
164 |
149 |
$898.64 |
| A5120 |
Skin barrier, wipe or swab |
125 |
101 |
$837.71 |
| A4362 |
Solid skin barrier |
13 |
12 |
$719.23 |
| A6446 |
Conform band s w>=3" <5"/yd |
12 |
12 |
$710.02 |
| V5266 |
Battery for hearing device |
28 |
27 |
$389.99 |
| A4314 |
Cath w/drainage 2-way latex |
32 |
26 |
$353.98 |
| A4253 |
Blood glucose/reagent strips |
13 |
13 |
$331.65 |
| A4450 |
Non-waterproof tape |
27 |
27 |
$216.24 |
| A4456 |
Adhesive remover, wipes |
28 |
27 |
$206.29 |
| A4245 |
Alcohol wipes per box |
12 |
12 |
$102.09 |