| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Large disposable underpad |
63,722 |
63,560 |
$2.93M |
| T4535 |
Disposable liner/shield/pad |
46,703 |
45,569 |
$2.07M |
| A4217 |
Sterile water/saline, 500 ml |
11,418 |
10,196 |
$746K |
| T4527 |
Adult size pull-on lg |
11,980 |
11,948 |
$621K |
| A6446 |
Conform band s w>=3" <5"/yd |
7,135 |
6,411 |
$543K |
| A6255 |
Absorpt drg >16<=48 in w/bdr |
4,550 |
4,090 |
$521K |
| T4526 |
Adult size pull-on med |
9,568 |
9,526 |
$401K |
| A6216 |
Non-sterile gauze<=16 sq in |
11,949 |
10,694 |
$362K |
| T4536 |
Reusable pull-on any size |
33,175 |
33,140 |
$353K |
| T4523 |
Adult size brief/diaper lg |
5,152 |
5,123 |
$348K |
| T4528 |
Adult size pull-on xl |
6,709 |
6,677 |
$334K |
| A6197 |
Alginate drsg >16 <=48 sq in |
751 |
706 |
$250K |
| A6250 |
Skin seal protect moisturizr |
41,654 |
41,580 |
$229K |
| A6455 |
Self-adher band >=5"/yd |
1,133 |
1,066 |
$210K |
| A6240 |
Hydrocolld drg filler paste |
1,644 |
1,540 |
$139K |
| T4524 |
Adult size brief/diaper xl |
2,427 |
2,413 |
$138K |
| A6211 |
Foam drg > 48 sq in w/o brdr |
261 |
246 |
$133K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
2,280 |
2,026 |
$132K |
| A6447 |
Conform band s w >=5"/yd |
1,334 |
1,251 |
$119K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
1,431 |
1,335 |
$101K |
| A5131 |
Appliance cleaner |
4,454 |
4,062 |
$93K |
| T4522 |
Adult size brief/diaper med |
1,653 |
1,634 |
$87K |
| A6402 |
Sterile gauze <= 16 sq in |
2,779 |
2,531 |
$80K |
| A4927 |
Non-sterile gloves |
4,447 |
4,206 |
$75K |
| T4537 |
Reusable underpad bed size |
2,985 |
2,982 |
$73K |
| T4525 |
Adult size pull-on sm |
1,760 |
1,757 |
$72K |
| A6248 |
Hydrogel drsg gel filler |
1,046 |
968 |
$72K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
186 |
179 |
$70K |
| E0601 |
Cont airway pressure device |
1,289 |
1,282 |
$54K |
| A4335 |
Incontinence supply |
24,588 |
24,542 |
$48K |
| A6196 |
Alginate dressing <=16 sq in |
377 |
357 |
$46K |
| E0245 |
Tub stool or bench |
847 |
845 |
$32K |
| E0603 |
Electric breast pump |
321 |
320 |
$22K |
| A6021 |
Collagen dressing <=16 sq in |
121 |
117 |
$21K |
| A4450 |
Non-waterproof tape |
1,233 |
1,090 |
$21K |
| K0001 |
Standard wheelchair |
729 |
722 |
$21K |
| A6010 |
Collagen based wound filler |
63 |
62 |
$15K |
| A5120 |
Skin barrier, wipe or swab |
823 |
781 |
$13K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
84 |
80 |
$13K |
| A4357 |
Bedside drainage bag |
283 |
272 |
$10K |
| A6266 |
Impreg gauze no h20/sal/yard |
301 |
275 |
$10K |
| A4358 |
Urinary leg or abdomen bag |
286 |
253 |
$7K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
78 |
76 |
$6K |
| A6212 |
Foam drg <=16 sq in w/border |
27 |
25 |
$6K |
| A6258 |
Transparent film >16<=48 in |
77 |
66 |
$5K |
| E0143 |
Walker folding wheeled w/o s |
76 |
76 |
$4K |
| E0570 |
Nebulizer with compression |
40 |
37 |
$4K |
| A4333 |
Urinary cath anchor device |
101 |
93 |
$3K |
| A7035 |
Pos airway press headgear |
136 |
135 |
$3K |
| A4385 |
Ost skn barrier sld ext wear |
25 |
24 |
$3K |
| A6219 |
Gauze <= 16 sq in w/border |
101 |
90 |
$3K |
| A4389 |
Drainable pch w st wear barr |
43 |
12 |
$3K |
| V5008 |
Hearing screening |
146 |
145 |
$2K |
| A4407 |
Ext wear ost skn barr <=4sq" |
12 |
12 |
$2K |
| A7037 |
Pos airway pressure tubing |
97 |
97 |
$2K |
| A7005 |
Nondisposable nebulizer set |
100 |
97 |
$2K |
| A7038 |
Pos airway pressure filter |
115 |
114 |
$2K |
| A4314 |
Cath w/drainage 2-way latex |
13 |
13 |
$2K |
| 99244 |
|
25 |
25 |
$2K |
| V5014 |
Hearing aid repair/modifying |
41 |
41 |
$2K |
| A7034 |
Nasal application device |
17 |
17 |
$983.90 |
| A4310 |
Insert tray w/o bag/cath |
25 |
25 |
$769.65 |
| E0156 |
Walker seat attachment |
91 |
91 |
$707.06 |
| A4456 |
Adhesive remover, wipes |
62 |
61 |
$666.32 |
| T4521 |
Adult size brief/diaper sm |
14 |
14 |
$582.29 |
| V5264 |
Ear mold/insert |
13 |
13 |
$577.74 |
| 92567 |
|
25 |
25 |
$524.69 |
| A4394 |
Ostomy pouch liq deodorant |
13 |
12 |
$253.23 |
| A7015 |
Aerosol mask used w nebulize |
102 |
99 |
$211.11 |
| E1038 |
Transport chair pt wt<=300lb |
18 |
18 |
$190.40 |