| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
4,849 |
4,740 |
$4.29M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
9,055 |
8,961 |
$2.34M |
| B4150 |
Ef complet w/intact nutrient |
3,905 |
3,820 |
$539K |
| T4534 |
Youth size pull-on |
3,544 |
3,532 |
$513K |
| T4527 |
Adult size pull-on lg |
3,731 |
3,702 |
$339K |
| T4526 |
Adult size pull-on med |
3,131 |
3,090 |
$278K |
| T4528 |
Adult size pull-on xl |
2,022 |
2,013 |
$248K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,651 |
1,609 |
$237K |
| A4927 |
Non-sterile gloves |
7,411 |
7,290 |
$217K |
| T4541 |
Large disposable underpad |
6,042 |
5,988 |
$216K |
| T4535 |
Disposable liner/shield/pad |
3,286 |
3,230 |
$171K |
| B4154 |
Ef spec metabolic noninherit |
657 |
637 |
$155K |
| T4523 |
Adult size brief/diaper lg |
1,317 |
1,297 |
$138K |
| T4522 |
Adult size brief/diaper med |
1,150 |
1,102 |
$108K |
| T4532 |
Ped size pull-on lg |
558 |
551 |
$86K |
| T4530 |
Ped size brief/diaper lg |
704 |
701 |
$86K |
| A4351 |
Straight tip urine catheter |
268 |
261 |
$44K |
| T4537 |
Reusable underpad bed size |
1,982 |
1,972 |
$31K |
| A9901 |
Delivery/set up/dispensing |
11,102 |
10,665 |
$29K |
| T4524 |
Adult size brief/diaper xl |
193 |
192 |
$27K |
| E0245 |
Tub stool or bench |
608 |
607 |
$25K |
| A6530 |
Compression stocking bk18-30 |
176 |
173 |
$21K |
| K0001 |
Standard wheelchair |
443 |
443 |
$21K |
| A4670 |
Automatic bp monitor, dial |
335 |
333 |
$18K |
| E0143 |
Walker folding wheeled w/o s |
350 |
348 |
$15K |
| E0849 |
Cervical pneum trac equip |
113 |
113 |
$7K |
| A4500 |
Below knee surgical stocking |
202 |
201 |
$6K |
| A6250 |
Skin seal protect moisturizr |
404 |
226 |
$5K |
| T4544 |
Adlt disp und/pull on abv xl |
24 |
24 |
$5K |
| E0241 |
Bath tub wall rail |
72 |
72 |
$3K |
| E0156 |
Walker seat attachment |
295 |
295 |
$3K |
| E0260 |
Hosp bed semi-electr w/ matt |
12 |
12 |
$2K |
| E0570 |
Nebulizer with compression |
25 |
25 |
$1K |
| E0100 |
Cane adjust/fixed with tip |
75 |
75 |
$874.05 |
| A4357 |
Bedside drainage bag |
182 |
181 |
$782.13 |
| E0244 |
Toilet seat raised |
12 |
12 |
$729.12 |