| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4534 |
Youth size pull-on |
5,929 |
5,740 |
$1.12M |
| B4161 |
Ef ped hydrolyzed/amino acid |
1,099 |
1,039 |
$1.11M |
| B4035 |
Enteral feed supp pump per d |
3,733 |
3,553 |
$1.01M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
2,323 |
2,181 |
$816K |
| B4149 |
Ef blenderized foods |
1,832 |
1,714 |
$699K |
| B9998 |
Enteral supp not otherwise c |
4,710 |
3,952 |
$600K |
| A4554 |
Disposable underpads |
6,127 |
5,725 |
$372K |
| B4088 |
Gastro/jejuno tube, low-pro |
2,242 |
1,649 |
$348K |
| A4927 |
Non-sterile gloves |
10,016 |
9,683 |
$290K |
| T4533 |
Youth size brief/diaper |
2,209 |
2,152 |
$276K |
| T4522 |
Adult size brief/diaper med |
1,980 |
1,901 |
$246K |
| T4526 |
Adult size pull-on med |
1,897 |
1,678 |
$235K |
| T4532 |
Ped size pull-on lg |
1,539 |
1,519 |
$190K |
| T4521 |
Adult size brief/diaper sm |
1,476 |
1,418 |
$184K |
| T4535 |
Disposable liner/shield/pad |
3,566 |
3,340 |
$182K |
| B4087 |
Gastro/jejuno tube, std |
1,302 |
1,109 |
$175K |
| A9286 |
Any hygienic item, device |
5,413 |
5,255 |
$163K |
| T4530 |
Ped size brief/diaper lg |
1,189 |
1,164 |
$122K |
| A6250 |
Skin seal protect moisturizr |
7,208 |
6,944 |
$120K |
| A4553 |
Nondisp underpads, all sizes |
1,696 |
1,642 |
$104K |
| B4150 |
Ef complet w/intact nutrient |
318 |
293 |
$54K |
| A9999 |
Dme supply or accessory, nos |
159 |
106 |
$51K |
| B9002 |
Enter nutr inf pump any type |
499 |
461 |
$34K |
| B4036 |
Enteral feed sup kit grav by |
399 |
381 |
$32K |
| T4527 |
Adult size pull-on lg |
168 |
158 |
$30K |
| A4213 |
20+ cc syringe only |
651 |
613 |
$28K |
| B4155 |
Ef incomplete/modular |
88 |
84 |
$21K |
| T4528 |
Adult size pull-on xl |
132 |
122 |
$20K |
| A4209 |
5+ cc sterile syringe&needle |
1,878 |
1,796 |
$18K |
| A6402 |
Sterile gauze <= 16 sq in |
970 |
931 |
$16K |
| T4525 |
Adult size pull-on sm |
157 |
157 |
$15K |
| B4103 |
Ef ped fluid and electrolyte |
81 |
61 |
$5K |
| A9901 |
Delivery/set up/dispensing |
202 |
113 |
$3K |
| B4104 |
Additive for enteral formula |
45 |
38 |
$3K |
| A4344 |
Cath indw foley 2 way silicn |
44 |
43 |
$1K |
| A4402 |
Lubricant per ounce |
83 |
81 |
$736.16 |