| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
65,046 |
58,622 |
$1.31M |
| T4527 |
Adult size pull-on lg |
14,577 |
13,629 |
$1.07M |
| T4526 |
Adult size pull-on med |
12,747 |
11,987 |
$772K |
| T4528 |
Adult size pull-on xl |
7,986 |
7,546 |
$725K |
| T4535 |
Disposable liner/shield/pad |
29,996 |
28,040 |
$718K |
| T4544 |
Adlt disp und/pull on abv xl |
3,819 |
3,584 |
$484K |
| T4534 |
Youth size pull-on |
5,654 |
5,357 |
$367K |
| A4335 |
Incontinence supply |
92,173 |
81,575 |
$353K |
| E0603 |
Electric breast pump |
3,256 |
3,217 |
$278K |
| A4253 |
Blood glucose/reagent strips |
13,991 |
11,445 |
$209K |
| T4523 |
Adult size brief/diaper lg |
2,362 |
2,200 |
$146K |
| T4524 |
Adult size brief/diaper xl |
1,716 |
1,630 |
$140K |
| T4522 |
Adult size brief/diaper med |
2,574 |
2,422 |
$138K |
| A4670 |
Automatic bp monitor, dial |
3,625 |
3,466 |
$138K |
| T4525 |
Adult size pull-on sm |
2,459 |
2,256 |
$130K |
| B4150 |
Ef complet w/intact nutrient |
2,351 |
2,122 |
$127K |
| A4353 |
Intermittent urinary cath |
420 |
262 |
$124K |
| T4543 |
Adult disp brief/diap abv xl |
1,256 |
1,143 |
$115K |
| A4351 |
Straight tip urine catheter |
878 |
753 |
$97K |
| E0240 |
Bath/shower chair |
1,757 |
1,561 |
$91K |
| T4530 |
Ped size brief/diaper lg |
1,482 |
1,409 |
$89K |
| B4154 |
Ef spec metabolic noninherit |
642 |
556 |
$63K |
| A4927 |
Non-sterile gloves |
12,489 |
11,337 |
$61K |
| E0143 |
Walker folding wheeled w/o s |
1,448 |
1,374 |
$56K |
| A4409 |
Ost skn barr convex <=4 sq i |
602 |
555 |
$49K |
| A4407 |
Ext wear ost skn barr <=4sq" |
284 |
248 |
$46K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
280 |
254 |
$44K |
| E1399 |
Durable medical equipment mi |
742 |
697 |
$43K |
| E2100 |
Bld glucose monitor w voice |
1,147 |
1,139 |
$43K |
| B4152 |
Ef calorie dense>/=1.5kcal |
271 |
255 |
$33K |
| A4259 |
Lancets per box |
11,101 |
10,004 |
$31K |
| K0001 |
Standard wheelchair |
111 |
110 |
$29K |
| T4532 |
Ped size pull-on lg |
290 |
282 |
$27K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
326 |
312 |
$27K |
| A6212 |
Foam drg <=16 sq in w/border |
280 |
235 |
$27K |
| A4385 |
Ost skn barrier sld ext wear |
341 |
330 |
$27K |
| E0149 |
Heavy duty wheeled walker |
230 |
222 |
$25K |
| A6250 |
Skin seal protect moisturizr |
4,580 |
4,290 |
$24K |
| E0163 |
Commode chair with fixed arm |
433 |
419 |
$22K |
| A4245 |
Alcohol wipes per box |
6,027 |
5,704 |
$21K |
| A4930 |
Sterile, gloves per pair |
643 |
585 |
$20K |
| A5063 |
Drain ostomy pouch w/flange |
347 |
334 |
$17K |
| T4521 |
Adult size brief/diaper sm |
322 |
316 |
$17K |
| A6530 |
Compression stocking bk18-30 |
414 |
324 |
$17K |
| E0445 |
Oximeter non-invasive |
125 |
120 |
$16K |
| T4541 |
Large disposable underpad |
1,066 |
1,020 |
$14K |
| A4520 |
Incontinence garment anytype |
17,572 |
14,577 |
$14K |
| A4425 |
Ost pch drain for barrier fl |
251 |
228 |
$13K |
| T4529 |
Ped size brief/diaper sm/med |
353 |
320 |
$13K |
| E0105 |
Cane adjust/fixed quad/3 pro |
441 |
425 |
$12K |
| A4362 |
Solid skin barrier |
238 |
227 |
$11K |
| E0247 |
Trans bench w/wo comm open |
206 |
194 |
$11K |
| A6402 |
Sterile gauze <= 16 sq in |
920 |
862 |
$9K |
| E0100 |
Cane adjust/fixed with tip |
835 |
812 |
$9K |
| E0248 |
Hdtrans bench w/wo comm open |
86 |
83 |
$8K |
| A5061 |
Pouch drainable w barrier at |
106 |
100 |
$8K |
| A4452 |
Waterproof tape |
643 |
424 |
$7K |
| A4432 |
Os pch urine w bar/fange/tap |
193 |
158 |
$7K |
| K0007 |
Extra heavy duty wheelchair |
55 |
54 |
$7K |
| A4406 |
Pectin based ostomy paste |
305 |
298 |
$6K |
| A4357 |
Bedside drainage bag |
1,023 |
854 |
$6K |
| E0244 |
Toilet seat raised |
285 |
260 |
$5K |
| A4394 |
Ostomy pouch liq deodorant |
252 |
248 |
$5K |
| A6446 |
Conform band s w>=3" <5"/yd |
337 |
219 |
$4K |
| E0156 |
Walker seat attachment |
1,356 |
1,275 |
$4K |
| A4349 |
Disposable male external cat |
178 |
115 |
$4K |
| A4456 |
Adhesive remover, wipes |
600 |
446 |
$3K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
52 |
40 |
$3K |
| A4358 |
Urinary leg or abdomen bag |
413 |
370 |
$2K |
| A5120 |
Skin barrier, wipe or swab |
439 |
397 |
$2K |
| A4344 |
Cath indw foley 2 way silicn |
249 |
220 |
$2K |
| K0004 |
High strength ltwt whlchr |
22 |
21 |
$2K |
| A4216 |
Sterile water/saline, 10 ml |
145 |
138 |
$2K |
| A4217 |
Sterile water/saline, 500 ml |
164 |
141 |
$2K |
| A4450 |
Non-waterproof tape |
590 |
445 |
$2K |
| A6216 |
Non-sterile gauze<=16 sq in |
328 |
306 |
$2K |
| E0245 |
Tub stool or bench |
48 |
48 |
$1K |
| A4371 |
Skin barrier powder per oz |
264 |
258 |
$1K |
| A4663 |
Dialysis blood pressure cuff |
123 |
116 |
$1K |
| E0607 |
Blood glucose monitor home |
436 |
292 |
$1K |
| A4256 |
Calibrator solution/chips |
667 |
636 |
$1K |
| A4402 |
Lubricant per ounce |
307 |
227 |
$1K |
| B4100 |
Food thickener oral |
27 |
24 |
$986.98 |
| A4310 |
Insert tray w/o bag/cath |
212 |
183 |
$876.43 |
| A4258 |
Lancet device each |
1,246 |
1,110 |
$876.27 |
| A4369 |
Skin barrier liquid per oz |
158 |
155 |
$825.37 |
| K0195 |
Elevating whlchair leg rests |
12 |
12 |
$790.23 |
| T4537 |
Reusable underpad bed size |
74 |
65 |
$517.82 |
| E0241 |
Bath tub wall rail |
51 |
27 |
$471.33 |
| A4322 |
Irrigation syringe |
15 |
12 |
$220.87 |