| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4526 |
Adult size pull-on med |
5,282 |
4,952 |
$506K |
| T4527 |
Adult size pull-on lg |
4,118 |
3,820 |
$442K |
| T4528 |
Adult size pull-on xl |
3,684 |
3,414 |
$402K |
| T4534 |
Youth size pull-on |
3,250 |
3,121 |
$400K |
| B4150 |
Ef complet w/intact nutrient |
3,428 |
2,298 |
$345K |
| T4523 |
Adult size brief/diaper lg |
2,771 |
2,620 |
$344K |
| A4554 |
Disposable underpads |
6,722 |
6,139 |
$326K |
| T4522 |
Adult size brief/diaper med |
2,752 |
2,571 |
$301K |
| T4535 |
Disposable liner/shield/pad |
5,271 |
4,892 |
$281K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,997 |
1,073 |
$250K |
| A4927 |
Non-sterile gloves |
11,323 |
9,651 |
$247K |
| A6530 |
Compression stocking bk18-30 |
2,605 |
2,325 |
$154K |
| A4351 |
Straight tip urine catheter |
1,176 |
874 |
$129K |
| T4524 |
Adult size brief/diaper xl |
819 |
722 |
$88K |
| E0570 |
Nebulizer with compression |
1,441 |
1,339 |
$79K |
| T4532 |
Ped size pull-on lg |
427 |
401 |
$36K |
| A4357 |
Bedside drainage bag |
3,429 |
2,835 |
$33K |
| A6250 |
Skin seal protect moisturizr |
653 |
467 |
$31K |
| A4407 |
Ext wear ost skn barr <=4sq" |
373 |
293 |
$27K |
| T4521 |
Adult size brief/diaper sm |
246 |
226 |
$23K |
| A4425 |
Ost pch drain for barrier fl |
641 |
535 |
$23K |
| A6212 |
Foam drg <=16 sq in w/border |
159 |
129 |
$23K |
| E0114 |
Crutch underarm pair no wood |
665 |
592 |
$22K |
| L3908 |
Who cock-up nonmolde pre ots |
799 |
594 |
$21K |
| K0001 |
Standard wheelchair |
521 |
418 |
$20K |
| A4310 |
Insert tray w/o bag/cath |
1,730 |
1,450 |
$15K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
44 |
38 |
$15K |
| A4338 |
Indwelling catheter latex |
1,030 |
831 |
$14K |
| A4553 |
Nondisp underpads, all sizes |
863 |
815 |
$13K |
| T4533 |
Youth size brief/diaper |
130 |
123 |
$12K |
| A4452 |
Waterproof tape |
664 |
527 |
$11K |
| K0739 |
Repair/svc dme non-oxygen eq |
158 |
111 |
$10K |
| E0143 |
Walker folding wheeled w/o s |
225 |
200 |
$8K |
| A4349 |
Disposable male external cat |
283 |
232 |
$8K |
| B4100 |
Food thickener oral |
24 |
24 |
$8K |
| L1812 |
Ko elastic w/joints pre ots |
111 |
100 |
$7K |
| A4409 |
Ost skn barr convex <=4 sq i |
97 |
74 |
$5K |
| A4456 |
Adhesive remover, wipes |
679 |
560 |
$5K |
| A4358 |
Urinary leg or abdomen bag |
1,003 |
846 |
$5K |
| A6216 |
Non-sterile gauze<=16 sq in |
511 |
414 |
$4K |
| A4344 |
Cath indw foley 2 way silicn |
256 |
185 |
$4K |
| E0245 |
Tub stool or bench |
75 |
67 |
$3K |
| A5120 |
Skin barrier, wipe or swab |
480 |
394 |
$3K |
| A6533 |
Gc stocking thighlngth 18-30 |
58 |
48 |
$3K |
| L4386 |
Non-pneum walk boot pre cst |
26 |
24 |
$3K |
| A4406 |
Pectin based ostomy paste |
335 |
260 |
$3K |
| E0720 |
Tens two lead |
69 |
58 |
$2K |
| A5063 |
Drain ostomy pouch w/flange |
106 |
84 |
$2K |
| A4670 |
Automatic bp monitor, dial |
40 |
38 |
$2K |
| A6260 |
Wound cleanser any type/size |
126 |
93 |
$2K |
| A4595 |
Tens suppl 2 lead per month |
246 |
230 |
$1K |
| A4335 |
Incontinence supply |
119 |
84 |
$1K |
| A4320 |
Irrigation tray |
65 |
53 |
$1K |
| L1820 |
Ko elas w/ condyle pads & jo |
14 |
12 |
$741.80 |
| T4525 |
Adult size pull-on sm |
13 |
13 |
$604.42 |
| A4402 |
Lubricant per ounce |
343 |
295 |
$388.38 |
| A4333 |
Urinary cath anchor device |
51 |
49 |
$356.14 |
| A7003 |
Nebulizer administration set |
85 |
77 |
$168.44 |
| A7015 |
Aerosol mask used w nebulize |
108 |
107 |
$108.77 |
| A4331 |
Extension drainage tubing |
12 |
12 |
$4.67 |