| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Large disposable underpad |
2,343 |
2,308 |
$150K |
| A4385 |
Ost skn barrier sld ext wear |
1,711 |
1,636 |
$91K |
| T4527 |
Adult size pull-on lg |
779 |
770 |
$83K |
| T4535 |
Disposable liner/shield/pad |
1,685 |
1,633 |
$75K |
| T4526 |
Adult size pull-on med |
452 |
440 |
$51K |
| A4927 |
Non-sterile gloves |
2,262 |
2,221 |
$32K |
| A4407 |
Ext wear ost skn barr <=4sq" |
376 |
349 |
$21K |
| A4670 |
Automatic bp monitor, dial |
281 |
271 |
$15K |
| A4425 |
Ost pch drain for barrier fl |
448 |
432 |
$14K |
| A6402 |
Sterile gauze <= 16 sq in |
803 |
717 |
$13K |
| A5063 |
Drain ostomy pouch w/flange |
219 |
213 |
$6K |
| E0603 |
Electric breast pump |
61 |
48 |
$6K |
| A4452 |
Waterproof tape |
172 |
159 |
$4K |
| A4357 |
Bedside drainage bag |
357 |
346 |
$4K |
| A4409 |
Ost skn barr convex <=4 sq i |
38 |
36 |
$2K |
| A6530 |
Compression stocking bk18-30 |
29 |
28 |
$2K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
16 |
14 |
$1K |
| A4456 |
Adhesive remover, wipes |
203 |
197 |
$995.00 |
| A4394 |
Ostomy pouch liq deodorant |
76 |
76 |
$678.76 |
| A4358 |
Urinary leg or abdomen bag |
83 |
74 |
$590.08 |
| A4371 |
Skin barrier powder per oz |
178 |
169 |
$357.10 |
| A5120 |
Skin barrier, wipe or swab |
42 |
39 |
$314.23 |
| A4367 |
Ostomy belt |
55 |
51 |
$155.69 |