| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4353 |
Intermittent urinary cath |
6,052 |
5,391 |
$2.88M |
| T4534 |
Youth size pull-on |
5,505 |
5,373 |
$505K |
| A4554 |
Disposable underpads |
9,551 |
9,232 |
$397K |
| A4351 |
Straight tip urine catheter |
2,829 |
2,474 |
$327K |
| A4927 |
Non-sterile gloves |
10,568 |
10,069 |
$240K |
| A9900 |
Supply/accessory/service |
6,447 |
5,996 |
$232K |
| T4530 |
Ped size brief/diaper lg |
2,625 |
2,528 |
$197K |
| T4522 |
Adult size brief/diaper med |
1,738 |
1,668 |
$144K |
| T4526 |
Adult size pull-on med |
1,690 |
1,621 |
$143K |
| T4532 |
Ped size pull-on lg |
1,248 |
1,201 |
$105K |
| T4521 |
Adult size brief/diaper sm |
1,191 |
1,158 |
$90K |
| T4525 |
Adult size pull-on sm |
938 |
913 |
$88K |
| T4527 |
Adult size pull-on lg |
760 |
739 |
$65K |
| T4523 |
Adult size brief/diaper lg |
759 |
730 |
$60K |
| A4349 |
Disposable male external cat |
893 |
663 |
$50K |
| T4535 |
Disposable liner/shield/pad |
1,184 |
1,151 |
$36K |
| A4402 |
Lubricant per ounce |
946 |
860 |
$21K |
| A4358 |
Urinary leg or abdomen bag |
940 |
773 |
$20K |
| A4357 |
Bedside drainage bag |
1,418 |
1,170 |
$20K |
| A4253 |
Blood glucose/reagent strips |
500 |
489 |
$18K |
| A4332 |
Lube sterile packet |
750 |
683 |
$18K |
| E1399 |
Durable medical equipment mi |
374 |
362 |
$18K |
| A4217 |
Sterile water/saline, 500 ml |
616 |
583 |
$15K |
| A4259 |
Lancets per box |
393 |
385 |
$7K |
| A4409 |
Ost skn barr convex <=4 sq i |
30 |
27 |
$3K |
| A5120 |
Skin barrier, wipe or swab |
356 |
306 |
$3K |
| A4352 |
Coude tip urinary catheter |
13 |
13 |
$2K |
| A6402 |
Sterile gauze <= 16 sq in |
39 |
38 |
$2K |
| A4216 |
Sterile water/saline, 10 ml |
37 |
36 |
$1K |
| A4362 |
Solid skin barrier |
96 |
85 |
$1K |
| A6212 |
Foam drg <=16 sq in w/border |
12 |
12 |
$757.31 |
| A4322 |
Irrigation syringe |
26 |
24 |
$448.58 |
| A4385 |
Ost skn barrier sld ext wear |
54 |
28 |
$371.04 |
| A4335 |
Incontinence supply |
33 |
32 |
$357.56 |
| A4406 |
Pectin based ostomy paste |
53 |
49 |
$245.90 |
| A4394 |
Ostomy pouch liq deodorant |
108 |
99 |
$204.70 |
| A4456 |
Adhesive remover, wipes |
151 |
132 |
$121.95 |
| A4425 |
Ost pch drain for barrier fl |
46 |
38 |
$96.14 |