| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4035 |
Enteral feed supp pump per d |
3,264 |
3,108 |
$878K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
2,334 |
2,243 |
$700K |
| A4554 |
Disposable underpads |
12,608 |
12,446 |
$443K |
| B9998 |
Enteral supp not otherwise c |
5,246 |
4,133 |
$410K |
| T4528 |
Adult size pull-on xl |
1,533 |
1,522 |
$301K |
| T4527 |
Adult size pull-on lg |
2,016 |
2,011 |
$293K |
| B4161 |
Ef ped hydrolyzed/amino acid |
379 |
358 |
$259K |
| T4526 |
Adult size pull-on med |
2,169 |
2,166 |
$249K |
| T4522 |
Adult size brief/diaper med |
2,076 |
2,058 |
$217K |
| B4150 |
Ef complet w/intact nutrient |
751 |
730 |
$199K |
| T4523 |
Adult size brief/diaper lg |
1,734 |
1,716 |
$178K |
| B4152 |
Ef calorie dense>/=1.5kcal |
490 |
482 |
$171K |
| B4149 |
Ef blenderized foods |
307 |
303 |
$102K |
| T4525 |
Adult size pull-on sm |
812 |
791 |
$86K |
| A4335 |
Incontinence supply |
14,956 |
14,773 |
$80K |
| T4535 |
Disposable liner/shield/pad |
1,775 |
1,768 |
$73K |
| T4524 |
Adult size brief/diaper xl |
557 |
556 |
$71K |
| A4606 |
Oxygen probe used w oximeter |
1,121 |
629 |
$69K |
| B4155 |
Ef incomplete/modular |
277 |
253 |
$64K |
| B4034 |
Enter feed supkit syr by day |
374 |
339 |
$46K |
| A4351 |
Straight tip urine catheter |
269 |
248 |
$35K |
| A4322 |
Irrigation syringe |
2,906 |
2,844 |
$22K |
| A7000 |
Disposable canister for pump |
1,166 |
1,145 |
$16K |
| A7002 |
Tubing used w suction pump |
1,305 |
1,265 |
$10K |
| A6216 |
Non-sterile gauze<=16 sq in |
2,751 |
2,545 |
$9K |
| A4628 |
Oropharyngeal suction cath |
1,099 |
1,072 |
$6K |
| A7003 |
Nebulizer administration set |
1,324 |
1,303 |
$5K |
| T4530 |
Ped size brief/diaper lg |
51 |
48 |
$4K |
| A6250 |
Skin seal protect moisturizr |
493 |
466 |
$3K |
| T4534 |
Youth size pull-on |
24 |
24 |
$3K |
| K0739 |
Repair/svc dme non-oxygen eq |
62 |
54 |
$2K |
| A4450 |
Non-waterproof tape |
1,303 |
1,246 |
$2K |
| A4253 |
Blood glucose/reagent strips |
24 |
24 |
$1K |
| A9900 |
Supply/accessory/service |
13 |
13 |
$1K |
| A4213 |
20+ cc syringe only |
528 |
524 |
$989.72 |
| A6402 |
Sterile gauze <= 16 sq in |
122 |
117 |
$922.65 |
| A4402 |
Lubricant per ounce |
178 |
172 |
$571.44 |
| A4216 |
Sterile water/saline, 10 ml |
50 |
48 |
$483.30 |