| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4150 |
Ef complet w/intact nutrient |
12,622 |
12,423 |
$1.52M |
| T4541 |
Large disposable underpad |
13,190 |
13,053 |
$1.02M |
| T4534 |
Youth size pull-on |
6,265 |
6,180 |
$789K |
| T4528 |
Adult size pull-on xl |
4,998 |
4,887 |
$697K |
| T4525 |
Adult size pull-on sm |
5,873 |
5,781 |
$682K |
| B4152 |
Ef calorie dense>/=1.5kcal |
3,131 |
3,054 |
$564K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
4,441 |
4,405 |
$540K |
| B4154 |
Ef spec metabolic noninherit |
2,954 |
2,903 |
$511K |
| T4526 |
Adult size pull-on med |
4,038 |
3,986 |
$507K |
| T4527 |
Adult size pull-on lg |
3,658 |
3,611 |
$495K |
| T4522 |
Adult size brief/diaper med |
2,708 |
2,672 |
$408K |
| A4927 |
Non-sterile gloves |
17,391 |
16,952 |
$407K |
| T4535 |
Disposable liner/shield/pad |
9,884 |
9,701 |
$255K |
| A4351 |
Straight tip urine catheter |
1,397 |
1,352 |
$246K |
| T4530 |
Ped size brief/diaper lg |
995 |
987 |
$146K |
| T4524 |
Adult size brief/diaper xl |
1,058 |
1,040 |
$144K |
| T4523 |
Adult size brief/diaper lg |
918 |
901 |
$134K |
| A6530 |
Compression stocking bk18-30 |
682 |
665 |
$70K |
| 87811 |
|
1,918 |
1,723 |
$68K |
| A4409 |
Ost skn barr convex <=4 sq i |
667 |
625 |
$61K |
| B4161 |
Ef ped hydrolyzed/amino acid |
163 |
160 |
$56K |
| G2023 |
Specimen collect covid-19 |
2,619 |
2,312 |
$53K |
| A4385 |
Ost skn barrier sld ext wear |
573 |
549 |
$36K |
| A4554 |
Disposable underpads |
1,243 |
1,220 |
$32K |
| A4253 |
Blood glucose/reagent strips |
696 |
666 |
$26K |
| B4035 |
Enteral feed supp pump per d |
83 |
77 |
$26K |
| K0001 |
Standard wheelchair |
1,174 |
1,138 |
$20K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
218 |
217 |
$17K |
| A4357 |
Bedside drainage bag |
1,178 |
1,100 |
$12K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
78 |
77 |
$11K |
| E0570 |
Nebulizer with compression |
642 |
616 |
$10K |
| V5266 |
Battery for hearing device |
557 |
547 |
$7K |
| A5120 |
Skin barrier, wipe or swab |
821 |
752 |
$7K |
| A4425 |
Ost pch drain for barrier fl |
115 |
113 |
$7K |
| A4432 |
Os pch urine w bar/fange/tap |
92 |
91 |
$6K |
| B4034 |
Enter feed supkit syr by day |
41 |
39 |
$5K |
| A5063 |
Drain ostomy pouch w/flange |
121 |
121 |
$5K |
| A6212 |
Foam drg <=16 sq in w/border |
29 |
26 |
$5K |
| M0243 |
Casirivi and imdevi inj |
19 |
18 |
$5K |
| 87426 |
|
182 |
160 |
$5K |
| A4358 |
Urinary leg or abdomen bag |
535 |
500 |
$4K |
| A6402 |
Sterile gauze <= 16 sq in |
549 |
528 |
$4K |
| A4362 |
Solid skin barrier |
76 |
68 |
$3K |
| E0607 |
Blood glucose monitor home |
50 |
49 |
$3K |
| A4456 |
Adhesive remover, wipes |
242 |
236 |
$3K |
| A4406 |
Pectin based ostomy paste |
187 |
172 |
$2K |
| E0118 |
Crutch substitute |
118 |
117 |
$2K |
| A4402 |
Lubricant per ounce |
330 |
321 |
$2K |
| E0260 |
Hosp bed semi-electr w/ matt |
95 |
95 |
$2K |
| A4407 |
Ext wear ost skn barr <=4sq" |
12 |
12 |
$1K |
| A4215 |
Sterile needle |
19 |
19 |
$1K |
| A4670 |
Automatic bp monitor, dial |
17 |
17 |
$977.84 |
| A4419 |
Ost pch for bar w flange/flt |
13 |
12 |
$956.88 |
| A5500 |
Diab shoe for density insert |
17 |
12 |
$930.44 |
| A7005 |
Nondisposable nebulizer set |
34 |
34 |
$843.84 |
| A4247 |
Betadine/iodine swabs/wipes |
13 |
12 |
$733.18 |
| A4450 |
Non-waterproof tape |
62 |
62 |
$530.06 |
| A4245 |
Alcohol wipes per box |
25 |
25 |
$335.17 |
| K0739 |
Repair/svc dme non-oxygen eq |
14 |
13 |
$295.89 |
| A4259 |
Lancets per box |
165 |
156 |
$290.27 |
| A7015 |
Aerosol mask used w nebulize |
147 |
147 |
$225.75 |
| A4371 |
Skin barrier powder per oz |
82 |
78 |
$201.33 |
| A7013 |
Disposable compressor filter |
100 |
100 |
$101.41 |
| A4258 |
Lancet device each |
46 |
45 |
$77.47 |
| A7003 |
Nebulizer administration set |
14 |
14 |
$49.26 |
| 0002A |
|
29 |
29 |
$37.25 |
| 90688 |
|
20 |
20 |
$36.82 |
| 90686 |
|
89 |
89 |
$20.52 |
| G0008 |
Admin influenza virus vac |
433 |
433 |
$17.40 |
| 0012A |
|
338 |
338 |
$17.07 |
| 0011A |
|
335 |
331 |
$3.30 |
| 90694 |
|
120 |
120 |
$0.00 |
| 90656 |
|
29 |
29 |
$0.00 |
| 0064A |
|
467 |
467 |
$0.00 |
| 90480 |
|
188 |
188 |
$0.00 |
| 90674 |
|
63 |
63 |
$0.00 |
| 0134A |
|
67 |
67 |
$0.00 |
| 0001A |
|
22 |
22 |
$0.00 |
| 0124A |
|
30 |
30 |
$0.00 |
| Q0244 |
Casirivi and imdevi 1200 mg |
16 |
15 |
$0.00 |
| 0054A |
|
12 |
12 |
$0.00 |
| 91320 |
|
66 |
66 |
$0.00 |
| 91322 |
|
103 |
103 |
$0.00 |
| 90661 |
|
17 |
17 |
$0.00 |
| 0004A |
|
30 |
30 |
$0.00 |
| 90653 |
|
41 |
41 |
$0.00 |