| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S5199 |
Personal care item nos each |
173,342 |
150,491 |
$18.89M |
| T4527 |
Adult size pull-on lg |
356,458 |
317,258 |
$17.21M |
| A4554 |
Disposable underpads |
571,503 |
540,333 |
$16.19M |
| A4335 |
Incontinence supply |
612,963 |
500,208 |
$14.81M |
| T4526 |
Adult size pull-on med |
326,106 |
291,326 |
$14.39M |
| T4535 |
Disposable liner/shield/pad |
622,541 |
576,772 |
$12.90M |
| T4528 |
Adult size pull-on xl |
202,118 |
177,138 |
$12.12M |
| T4541 |
Large disposable underpad |
472,964 |
373,135 |
$11.79M |
| T4523 |
Adult size brief/diaper lg |
256,625 |
235,115 |
$11.72M |
| T4524 |
Adult size brief/diaper xl |
179,908 |
161,369 |
$10.55M |
| T4522 |
Adult size brief/diaper med |
261,660 |
240,252 |
$9.53M |
| T4543 |
Adult disp brief/diap abv xl |
83,474 |
72,779 |
$8.47M |
| T4534 |
Youth size pull-on |
116,850 |
104,932 |
$7.40M |
| T4544 |
Adlt disp und/pull on abv xl |
71,790 |
61,987 |
$6.51M |
| A4927 |
Non-sterile gloves |
785,419 |
692,758 |
$5.52M |
| T4537 |
Reusable underpad bed size |
179,125 |
157,879 |
$4.29M |
| T4525 |
Adult size pull-on sm |
62,055 |
55,785 |
$3.12M |
| L0650 |
Lso sc r ant/pos pnl pre ots |
5,450 |
5,149 |
$3.11M |
| E0603 |
Electric breast pump |
34,531 |
30,911 |
$3.08M |
| T4521 |
Adult size brief/diaper sm |
49,920 |
46,609 |
$2.29M |
| A4351 |
Straight tip urine catheter |
22,456 |
19,382 |
$1.83M |
| B4150 |
Ef complet w/intact nutrient |
46,112 |
41,273 |
$1.76M |
| T4530 |
Ped size brief/diaper lg |
38,642 |
34,953 |
$1.59M |
| A9999 |
Dme supply or accessory, nos |
38,881 |
34,655 |
$1.52M |
| A4353 |
Intermittent urinary cath |
4,069 |
3,371 |
$1.28M |
| A4520 |
Incontinence garment anytype |
57,193 |
42,043 |
$1.27M |
| L1833 |
Ko adj jnt pos r sup pre ots |
3,748 |
3,489 |
$1.25M |
| T4533 |
Youth size brief/diaper |
20,124 |
18,270 |
$1.23M |
| A6197 |
Alginate drsg >16 <=48 sq in |
9,931 |
8,214 |
$1.18M |
| A6212 |
Foam drg <=16 sq in w/border |
18,764 |
15,298 |
$1.09M |
| A6250 |
Skin seal protect moisturizr |
98,251 |
88,674 |
$1.09M |
| B4154 |
Ef spec metabolic noninherit |
24,416 |
18,501 |
$911K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
19,495 |
15,891 |
$844K |
| B4152 |
Ef calorie dense>/=1.5kcal |
15,176 |
13,440 |
$843K |
| A4670 |
Automatic bp monitor, dial |
25,549 |
24,506 |
$829K |
| A4385 |
Ost skn barrier sld ext wear |
23,532 |
20,684 |
$817K |
| A4409 |
Ost skn barr convex <=4 sq i |
21,459 |
18,825 |
$811K |
| A5120 |
Skin barrier, wipe or swab |
87,589 |
76,338 |
$780K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
7,642 |
6,090 |
$677K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
6,815 |
5,629 |
$607K |
| E0240 |
Bath/shower chair |
9,879 |
8,820 |
$582K |
| A4407 |
Ext wear ost skn barr <=4sq" |
11,428 |
9,886 |
$500K |
| A4425 |
Ost pch drain for barrier fl |
18,150 |
15,968 |
$457K |
| A4352 |
Coude tip urinary catheter |
1,775 |
1,517 |
$427K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
3,280 |
2,810 |
$416K |
| A6021 |
Collagen dressing <=16 sq in |
3,735 |
3,086 |
$396K |
| A6446 |
Conform band s w>=3" <5"/yd |
19,843 |
16,920 |
$384K |
| E0143 |
Walker folding wheeled w/o s |
9,350 |
8,793 |
$379K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
11,486 |
10,108 |
$374K |
| A4452 |
Waterproof tape |
30,021 |
25,673 |
$347K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
2,979 |
2,453 |
$340K |
| E0445 |
Oximeter non-invasive |
2,134 |
1,917 |
$328K |
| A6022 |
Collagen drsg>16<=48 sq in |
2,295 |
1,992 |
$326K |
| E1399 |
Durable medical equipment mi |
34,650 |
33,031 |
$321K |
| A5063 |
Drain ostomy pouch w/flange |
16,202 |
14,250 |
$307K |
| A6196 |
Alginate dressing <=16 sq in |
5,167 |
4,263 |
$299K |
| A4253 |
Blood glucose/reagent strips |
21,187 |
19,596 |
$284K |
| A6216 |
Non-sterile gauze<=16 sq in |
39,262 |
34,426 |
$277K |
| A4362 |
Solid skin barrier |
11,699 |
10,358 |
$270K |
| T1999 |
Noc retail items andsupplies |
3,499 |
3,365 |
$260K |
| A6402 |
Sterile gauze <= 16 sq in |
35,256 |
30,819 |
$246K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
5,265 |
4,509 |
$245K |
| T4532 |
Ped size pull-on lg |
3,972 |
3,681 |
$232K |
| A4216 |
Sterile water/saline, 10 ml |
16,634 |
14,197 |
$228K |
| A4357 |
Bedside drainage bag |
30,817 |
26,510 |
$220K |
| A4424 |
Ost pch drain w bar & filter |
4,454 |
4,053 |
$198K |
| E0149 |
Heavy duty wheeled walker |
2,251 |
2,020 |
$196K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
5,835 |
5,080 |
$190K |
| A4595 |
Tens suppl 2 lead per month |
6,418 |
5,627 |
$179K |
| A4245 |
Alcohol wipes per box |
23,476 |
21,310 |
$178K |
| E0247 |
Trans bench w/wo comm open |
2,985 |
2,579 |
$169K |
| B4100 |
Food thickener oral |
4,168 |
3,340 |
$164K |
| E0163 |
Commode chair with fixed arm |
4,063 |
3,608 |
$153K |
| A4349 |
Disposable male external cat |
9,145 |
7,460 |
$153K |
| K0004 |
High strength ltwt whlchr |
434 |
358 |
$141K |
| A4419 |
Ost pch for bar w flange/flt |
5,061 |
4,313 |
$139K |
| A6260 |
Wound cleanser any type/size |
16,315 |
14,050 |
$138K |
| T4540 |
Reusable underpad chair size |
7,560 |
7,468 |
$137K |
| A4450 |
Non-waterproof tape |
20,336 |
18,071 |
$132K |
| A4432 |
Os pch urine w bar/fange/tap |
5,947 |
5,127 |
$130K |
| A4402 |
Lubricant per ounce |
20,695 |
19,489 |
$119K |
| L2397 |
Suspension sleeve lower ext |
2,168 |
2,055 |
$118K |
| A5061 |
Pouch drainable w barrier at |
3,199 |
2,955 |
$116K |
| A4388 |
Drainable pch w ex wear barr |
3,324 |
2,803 |
$112K |
| A4406 |
Pectin based ostomy paste |
14,457 |
12,896 |
$112K |
| A6198 |
Alginate dressing > 48 sq in |
855 |
619 |
$112K |
| L3809 |
Whfo w/o joints pre ots |
825 |
741 |
$110K |
| A4389 |
Drainable pch w st wear barr |
2,284 |
1,954 |
$109K |
| A6199 |
Alginate drsg wound filler |
2,079 |
1,794 |
$107K |
| A4456 |
Adhesive remover, wipes |
18,993 |
17,210 |
$102K |
| A6454 |
Self-adher band w>=3" <5"/yd |
6,269 |
4,987 |
$101K |
| T4542 |
Small disposable underpad |
5,091 |
4,483 |
$100K |
| A6530 |
Compression stocking bk18-30 |
3,233 |
2,952 |
$99K |
| A4394 |
Ostomy pouch liq deodorant |
13,192 |
11,646 |
$98K |
| A4624 |
Tracheal suction tube |
1,453 |
1,181 |
$97K |
| K0001 |
Standard wheelchair |
492 |
422 |
$96K |
| A5056 |
1 pc ost pouch w filter |
2,355 |
2,065 |
$96K |
| A6220 |
Gauze >16 <=48 sq in w/bordr |
1,828 |
1,566 |
$94K |
| A5057 |
1 pc ost pou w built-in conv |
1,370 |
1,185 |
$93K |
| A9153 |
Multi-vitamin nos |
4,820 |
4,667 |
$93K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
3,036 |
2,720 |
$91K |
| A6258 |
Transparent film >16<=48 in |
2,003 |
1,788 |
$91K |
| A9150 |
Misc/exper non-prescript dru |
7,523 |
7,114 |
$90K |
| A6240 |
Hydrocolld drg filler paste |
2,708 |
2,464 |
$90K |
| A6449 |
Lt compres band >=3" <5"/yd |
4,470 |
3,830 |
$89K |
| A6452 |
High compres band w>=3"<5"yd |
1,104 |
899 |
$85K |
| A4217 |
Sterile water/saline, 500 ml |
9,303 |
8,399 |
$83K |
| E0248 |
Hdtrans bench w/wo comm open |
705 |
540 |
$80K |
| E0244 |
Toilet seat raised |
3,751 |
3,531 |
$80K |
| A6219 |
Gauze <= 16 sq in w/border |
5,701 |
4,983 |
$79K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
2,248 |
1,891 |
$78K |
| E0156 |
Walker seat attachment |
9,093 |
8,449 |
$77K |
| A6248 |
Hydrogel drsg gel filler |
2,317 |
2,072 |
$76K |
| E0241 |
Bath tub wall rail |
3,907 |
3,707 |
$75K |
| A4322 |
Irrigation syringe |
4,717 |
3,993 |
$75K |
| A4358 |
Urinary leg or abdomen bag |
13,608 |
11,917 |
$74K |
| A4373 |
Skin barrier with flange |
2,062 |
1,842 |
$74K |
| E0245 |
Tub stool or bench |
3,060 |
2,970 |
$73K |
| T4531 |
Ped size pull-on sm/med |
1,365 |
1,246 |
$72K |
| E0105 |
Cane adjust/fixed quad/3 pro |
3,191 |
3,046 |
$72K |
| E0730 |
Tens four lead |
899 |
827 |
$71K |
| A4390 |
Drainable pch ex wear convex |
1,402 |
1,272 |
$71K |
| A6443 |
Conform band n/s w>=3"<5"/yd |
7,600 |
6,520 |
$69K |
| A4623 |
Tracheostomy inner cannula |
1,589 |
1,258 |
$67K |
| A6456 |
Zinc paste band w >=3"<5"/yd |
2,127 |
1,706 |
$67K |
| B4102 |
Ef adult fluids and electro |
1,643 |
1,313 |
$66K |
| A4930 |
Sterile, gloves per pair |
3,204 |
2,653 |
$66K |
| A4344 |
Cath indw foley 2 way silicn |
6,234 |
5,078 |
$60K |
| A4430 |
Ost urine pch w b/bltin conv |
1,129 |
1,035 |
$59K |
| A6457 |
Tubular dressing |
3,788 |
3,353 |
$57K |
| B9998 |
Enteral supp not otherwise c |
774 |
579 |
$56K |
| A5121 |
Solid skin barrier 6x6 |
1,552 |
1,261 |
$55K |
| A4332 |
Lube sterile packet |
8,821 |
7,200 |
$53K |
| B4035 |
Enteral feed supp pump per d |
1,480 |
1,080 |
$53K |
| A4310 |
Insert tray w/o bag/cath |
8,444 |
7,139 |
$48K |
| A6251 |
Absorpt drg <=16 sq in w/o b |
1,168 |
1,020 |
$45K |
| A6450 |
Lt compres band >=5"/yd |
1,598 |
1,404 |
$44K |
| E0100 |
Cane adjust/fixed with tip |
4,868 |
4,673 |
$42K |
| A6266 |
Impreg gauze no h20/sal/yard |
2,178 |
1,905 |
$42K |
| A4320 |
Irrigation tray |
3,086 |
2,749 |
$42K |
| B4034 |
Enter feed supkit syr by day |
840 |
706 |
$41K |
| A6207 |
Contact layer >16<= 48 sq in |
1,162 |
929 |
$40K |
| B4155 |
Ef incomplete/modular |
485 |
426 |
$39K |
| A4427 |
Ost pch drain/barr lk flng/f |
1,801 |
1,592 |
$38K |
| E0215 |
Electric heat pad moist |
1,596 |
1,536 |
$37K |
| A4410 |
Ost skn barr extnd >4 sq |
823 |
681 |
$36K |
| A7526 |
Tracheostomy tube collar |
1,530 |
1,207 |
$34K |
| A4338 |
Indwelling catheter latex |
5,509 |
4,714 |
$33K |
| A4247 |
Betadine/iodine swabs/wipes |
1,937 |
1,608 |
$33K |
| A4259 |
Lancets per box |
15,162 |
14,375 |
$32K |
| E1639 |
Scale, each |
1,342 |
1,220 |
$31K |
| A6413 |
Adhesive bandage, first-aid |
3,083 |
3,005 |
$30K |
| E0570 |
Nebulizer with compression |
1,364 |
1,331 |
$30K |
| A4629 |
Tracheostomy care kit |
892 |
779 |
$30K |
| A6203 |
Composite drsg <= 16 sq in |
1,022 |
882 |
$30K |
| A4416 |
Ost pch clsd w barrier/filtr |
921 |
773 |
$30K |
| A4371 |
Skin barrier powder per oz |
11,661 |
10,642 |
$30K |
| A4428 |
Urine ost pouch w faucet/tap |
606 |
545 |
$30K |
| A5054 |
Clsd ostomy pouch w/flange |
1,085 |
984 |
$30K |
| A6533 |
Gc stocking thighlngth 18-30 |
1,225 |
1,160 |
$28K |
| A4215 |
Sterile needle |
2,125 |
2,065 |
$28K |
| E0607 |
Blood glucose monitor home |
2,077 |
1,818 |
$26K |
| A4405 |
Nonpectin based ostomy paste |
13,717 |
13,520 |
$26K |
| A4411 |
Ost skn barr extnd =4sq |
738 |
628 |
$25K |
| A6445 |
Conform band s w <3"/yd |
2,339 |
2,060 |
$25K |
| A6441 |
Pad band w>=3" <5"/yd |
2,309 |
1,828 |
$25K |
| L1906 |
Afo multilig ank sup pre ots |
380 |
339 |
$25K |
| A6235 |
Hydrocolld drg >16<=48 w/o b |
300 |
245 |
$24K |
| A4333 |
Urinary cath anchor device |
4,904 |
4,189 |
$23K |
| A4369 |
Skin barrier liquid per oz |
7,147 |
6,365 |
$22K |
| B4036 |
Enteral feed sup kit grav by |
184 |
167 |
$21K |
| E0190 |
Positioning cushion |
757 |
699 |
$21K |
| A4314 |
Cath w/drainage 2-way latex |
2,544 |
2,252 |
$20K |
| A4315 |
Cath w/drainage 2-way silcne |
1,638 |
1,431 |
$19K |
| B4088 |
Gastro/jejuno tube, low-pro |
646 |
507 |
$19K |
| A4367 |
Ostomy belt |
4,969 |
4,594 |
$18K |
| A6403 |
Sterile gauze>16 <= 48 sq in |
928 |
829 |
$18K |
| E0315 |
Bed accessory brd/tbl/supprt |
557 |
527 |
$18K |
| E2100 |
Bld glucose monitor w voice |
512 |
510 |
$16K |
| A4412 |
Ost pouch drain high output |
507 |
455 |
$14K |
| A9281 |
Reaching/grabbing device |
1,439 |
1,344 |
$14K |
| A9900 |
Supply/accessory/service |
748 |
709 |
$12K |
| L0625 |
Lo flex l1-below l5 pre ots |
560 |
506 |
$12K |
| A4649 |
Surgical supplies |
545 |
402 |
$12K |
| S8490 |
100 insulin syringes |
2,243 |
2,123 |
$12K |
| A6257 |
Transparent film <= 16 sq in |
714 |
646 |
$11K |
| L3908 |
Who cock-up nonmolde pre ots |
483 |
430 |
$11K |
| E0243 |
Toilet rail |
406 |
383 |
$10K |
| E0168 |
Heavyduty/wide commode chair |
152 |
144 |
$10K |
| A6407 |
Packing strips, non-impreg |
596 |
534 |
$9K |
| E0325 |
Urinal male jug-type |
2,808 |
2,555 |
$9K |
| A4663 |
Dialysis blood pressure cuff |
1,544 |
1,473 |
$9K |
| A4415 |
Ost skn barr w/o conv >4 sqi |
329 |
299 |
$9K |
| A4455 |
Adhesive remover per ounce |
3,668 |
3,245 |
$9K |
| T4529 |
Ped size brief/diaper sm/med |
332 |
321 |
$8K |
| A4364 |
Adhesive, liquid or equal |
1,750 |
1,572 |
$8K |
| A4340 |
Indwelling catheter special |
557 |
482 |
$8K |
| A7048 |
Vacuum drain bottle/tube kit |
31 |
25 |
$8K |
| E0165 |
Commode chair with detacharm |
92 |
88 |
$8K |
| A4331 |
Extension drainage tubing |
2,600 |
2,265 |
$6K |
| A6545 |
Grad com non-elastic bk surg |
85 |
69 |
$6K |
| B4149 |
Ef blenderized foods |
54 |
37 |
$6K |
| A4354 |
Cath insertion tray w/bag |
1,269 |
1,068 |
$6K |
| A4334 |
Urinary cath leg strap |
2,826 |
2,449 |
$5K |
| A4311 |
Catheter w/o bag 2-way latex |
760 |
660 |
$5K |
| E2601 |
Gen w/c cushion wdth < 22 in |
275 |
241 |
$4K |
| A6442 |
Conform band n/s w<3"/yd |
624 |
543 |
$4K |
| A6237 |
Hydrocolld drg <=16 in w/bdr |
105 |
93 |
$4K |
| A6447 |
Conform band s w >=5"/yd |
135 |
118 |
$4K |
| A5200 |
Percutaneous catheter anchor |
206 |
181 |
$4K |
| K0007 |
Extra heavy duty wheelchair |
14 |
12 |
$3K |
| A6154 |
Wound pouch each |
28 |
24 |
$3K |
| T4539 |
Reuse diaper/brief any size |
112 |
112 |
$3K |
| A4467 |
Belt strap sleev grmnt cover |
352 |
340 |
$3K |
| A6204 |
Composite drsg >16<=48 sq in |
47 |
39 |
$3K |
| A6206 |
Contact layer <= 16 sq in |
65 |
58 |
$3K |
| E0602 |
Manual breast pump |
38 |
38 |
$3K |
| A4256 |
Calibrator solution/chips |
1,153 |
1,026 |
$2K |
| A4628 |
Oropharyngeal suction cath |
149 |
96 |
$2K |
| E0560 |
Humidifier supplemental w/ i |
87 |
86 |
$2K |
| A6224 |
Gauze > 48 in no w/sal w/o b |
40 |
38 |
$2K |
| A6455 |
Self-adher band >=5"/yd |
47 |
39 |
$2K |
| E0191 |
Protector heel or elbow |
252 |
231 |
$2K |
| E0135 |
Walker folding adjust/fixed |
44 |
39 |
$2K |
| A4246 |
Betadine/phisohex solution |
426 |
393 |
$2K |
| E0274 |
Over-bed table |
46 |
39 |
$2K |
| V5266 |
Battery for hearing device |
28 |
27 |
$1K |
| A6259 |
Transparent film > 48 sq in |
31 |
27 |
$1K |
| A4657 |
Syringe w/wo needle |
385 |
329 |
$1K |
| A7003 |
Nebulizer administration set |
1,631 |
1,573 |
$1K |
| A4258 |
Lancet device each |
1,523 |
1,433 |
$1K |
| A4413 |
2 pc drainable ost pouch |
49 |
39 |
$1K |
| A9300 |
Exercise equipment |
24 |
13 |
$914.38 |
| A4392 |
Urinary pouch w st wear barr |
14 |
12 |
$845.83 |
| A9270 |
Non-covered item or service |
9,426 |
8,040 |
$843.13 |
| E0275 |
Bed pan standard |
106 |
93 |
$832.02 |
| A4627 |
Spacer bag/reservoir |
330 |
325 |
$792.20 |
| A9273 |
Hot/cold botle/cap/col/wrap |
16 |
16 |
$787.84 |
| A4218 |
Sterile saline or water |
55 |
55 |
$677.63 |
| A7015 |
Aerosol mask used w nebulize |
970 |
949 |
$665.80 |
| L1820 |
Ko elas w/ condyle pads & jo |
12 |
12 |
$654.26 |
| E1038 |
Transport chair pt wt<=300lb |
13 |
12 |
$491.89 |
| E0246 |
Transfer tub rail attachment |
13 |
13 |
$443.17 |
| A4931 |
Reusable oral thermometer |
251 |
250 |
$347.43 |
| A6453 |
Self-adher band w <3"/yd |
24 |
24 |
$313.82 |
| A7000 |
Disposable canister for pump |
15 |
13 |
$266.85 |
| A4363 |
Ostomy clamp, replacement |
81 |
74 |
$260.36 |
| A4396 |
Peristomal hernia supprt blt |
13 |
13 |
$254.00 |
| A7018 |
Water distilled w/nebulizer |
125 |
122 |
$233.19 |
| A6217 |
Non-sterile gauze>16<=48 sq |
15 |
14 |
$92.72 |
| A4928 |
Surgical mask |
57 |
54 |
$65.82 |
| A9286 |
Any hygienic item, device |
96 |
54 |
$38.40 |
| A4244 |
Alcohol or peroxide per pint |
12 |
12 |
$13.51 |
| A4312 |
Cath w/o bag 2-way silicone |
14 |
14 |
$11.53 |
| B4161 |
Ef ped hydrolyzed/amino acid |
71 |
54 |
$0.00 |