| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
11,312 |
11,294 |
$841K |
| T4522 |
Adult size brief/diaper med |
4,906 |
4,895 |
$588K |
| B4035 |
Enteral feed supp pump per d |
3,988 |
3,970 |
$579K |
| B4150 |
Ef complet w/intact nutrient |
2,564 |
2,553 |
$436K |
| T4523 |
Adult size brief/diaper lg |
2,597 |
2,591 |
$380K |
| A4624 |
Tracheal suction tube |
1,203 |
1,198 |
$270K |
| T4533 |
Youth size brief/diaper |
2,715 |
2,712 |
$239K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,506 |
1,495 |
$238K |
| T4524 |
Adult size brief/diaper xl |
1,349 |
1,349 |
$220K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,114 |
1,112 |
$208K |
| T4537 |
Reusable underpad bed size |
4,566 |
4,563 |
$156K |
| B4161 |
Ef ped hydrolyzed/amino acid |
156 |
154 |
$134K |
| E1390 |
Oxygen concentrator |
921 |
916 |
$110K |
| B4088 |
Gastro/jejuno tube, low-pro |
759 |
758 |
$104K |
| T4521 |
Adult size brief/diaper sm |
920 |
918 |
$99K |
| A6402 |
Sterile gauze <= 16 sq in |
3,135 |
3,123 |
$55K |
| A4927 |
Non-sterile gloves |
10,009 |
9,997 |
$44K |
| E0445 |
Oximeter non-invasive |
296 |
295 |
$44K |
| A4629 |
Tracheostomy care kit |
347 |
345 |
$42K |
| T4535 |
Disposable liner/shield/pad |
1,910 |
1,909 |
$37K |
| A4322 |
Irrigation syringe |
2,208 |
2,202 |
$24K |
| A7000 |
Disposable canister for pump |
1,494 |
1,492 |
$23K |
| T4540 |
Reusable underpad chair size |
1,174 |
1,174 |
$22K |
| B4154 |
Ef spec metabolic noninherit |
111 |
107 |
$21K |
| E0431 |
Portable gaseous 02 |
844 |
836 |
$20K |
| A4217 |
Sterile water/saline, 500 ml |
1,281 |
1,278 |
$16K |
| A4450 |
Non-waterproof tape |
1,607 |
1,602 |
$10K |
| A4628 |
Oropharyngeal suction cath |
961 |
958 |
$8K |
| A7002 |
Tubing used w suction pump |
1,721 |
1,715 |
$8K |
| A7003 |
Nebulizer administration set |
698 |
695 |
$3K |
| A7526 |
Tracheostomy tube collar |
37 |
37 |
$3K |
| B4034 |
Enter feed supkit syr by day |
36 |
36 |
$1K |