| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Large disposable underpad |
1,800,431 |
1,787,986 |
$93.45M |
| T4535 |
Disposable liner/shield/pad |
1,278,714 |
1,171,607 |
$49.40M |
| T4527 |
Adult size pull-on lg |
603,242 |
598,860 |
$38.60M |
| T4526 |
Adult size pull-on med |
681,007 |
676,478 |
$36.15M |
| T4528 |
Adult size pull-on xl |
361,110 |
358,346 |
$23.64M |
| T4523 |
Adult size brief/diaper lg |
283,226 |
280,507 |
$23.41M |
| B4035 |
Enteral feed supp pump per d |
155,361 |
149,571 |
$21.11M |
| T4534 |
Youth size pull-on |
148,395 |
146,729 |
$19.04M |
| A4351 |
Straight tip urine catheter |
81,170 |
76,852 |
$18.53M |
| T4522 |
Adult size brief/diaper med |
264,207 |
261,560 |
$18.43M |
| T4530 |
Ped size brief/diaper lg |
154,964 |
152,778 |
$14.25M |
| T4524 |
Adult size brief/diaper xl |
174,881 |
173,239 |
$14.00M |
| B9998 |
Enteral supp not otherwise c |
193,807 |
174,427 |
$12.03M |
| B4088 |
Gastro/jejuno tube, low-pro |
76,734 |
74,712 |
$10.24M |
| A6250 |
Skin seal protect moisturizr |
833,860 |
827,773 |
$10.21M |
| A4335 |
Incontinence supply |
865,869 |
858,096 |
$9.22M |
| T4525 |
Adult size pull-on sm |
135,993 |
134,863 |
$6.84M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
41,021 |
39,325 |
$6.59M |
| T4537 |
Reusable underpad bed size |
238,092 |
236,500 |
$6.26M |
| B4161 |
Ef ped hydrolyzed/amino acid |
13,434 |
12,924 |
$6.10M |
| A4927 |
Non-sterile gloves |
364,288 |
358,607 |
$5.48M |
| A4385 |
Ost skn barrier sld ext wear |
42,178 |
41,005 |
$5.15M |
| A4409 |
Ost skn barr convex <=4 sq i |
27,054 |
26,360 |
$4.49M |
| B9002 |
Enter nutr inf pump any type |
7,388 |
7,175 |
$3.80M |
| A4322 |
Irrigation syringe |
160,072 |
147,325 |
$3.61M |
| T4521 |
Adult size brief/diaper sm |
48,835 |
48,167 |
$3.28M |
| S9999 |
Sales tax |
378,869 |
368,248 |
$3.23M |
| T4532 |
Ped size pull-on lg |
27,108 |
26,647 |
$2.74M |
| A4407 |
Ext wear ost skn barr <=4sq" |
12,189 |
11,916 |
$2.66M |
| A4425 |
Ost pch drain for barrier fl |
27,784 |
27,018 |
$2.38M |
| A4352 |
Coude tip urinary catheter |
7,163 |
6,816 |
$2.36M |
| T4544 |
Adlt disp und/pull on abv xl |
13,772 |
13,621 |
$2.23M |
| A6197 |
Alginate drsg >16 <=48 sq in |
4,580 |
4,341 |
$2.16M |
| B4150 |
Ef complet w/intact nutrient |
15,235 |
14,609 |
$1.96M |
| A4362 |
Solid skin barrier |
23,174 |
22,744 |
$1.76M |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
11,660 |
11,329 |
$1.56M |
| A6212 |
Foam drg <=16 sq in w/border |
12,153 |
11,385 |
$1.54M |
| A4353 |
Intermittent urinary cath |
2,953 |
2,836 |
$1.49M |
| B4152 |
Ef calorie dense>/=1.5kcal |
10,195 |
9,785 |
$1.48M |
| A5057 |
1 pc ost pou w built-in conv |
4,568 |
4,425 |
$1.27M |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
3,467 |
3,240 |
$1.24M |
| B4153 |
Ef hydrolyzed/amino acids |
1,777 |
1,659 |
$1.24M |
| B4149 |
Ef blenderized foods |
2,866 |
2,738 |
$1.16M |
| A5063 |
Drain ostomy pouch w/flange |
16,586 |
16,174 |
$1.12M |
| B4154 |
Ef spec metabolic noninherit |
4,034 |
3,744 |
$979K |
| A5061 |
Pouch drainable w barrier at |
9,258 |
9,124 |
$944K |
| A4424 |
Ost pch drain w bar & filter |
6,964 |
6,787 |
$907K |
| A4410 |
Ost skn barr extnd >4 sq |
4,322 |
4,074 |
$890K |
| A4388 |
Drainable pch w ex wear barr |
7,817 |
7,621 |
$890K |
| A4357 |
Bedside drainage bag |
39,295 |
38,361 |
$877K |
| T5999 |
Supply, nos |
3,863 |
3,536 |
$872K |
| T4543 |
Adult disp brief/diap abv xl |
4,637 |
4,597 |
$845K |
| A5056 |
1 pc ost pouch w filter |
6,321 |
6,101 |
$842K |
| A6402 |
Sterile gauze <= 16 sq in |
90,497 |
87,441 |
$809K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
2,481 |
2,368 |
$765K |
| A6446 |
Conform band s w>=3" <5"/yd |
15,108 |
14,578 |
$716K |
| A4349 |
Disposable male external cat |
16,389 |
15,906 |
$701K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
8,313 |
7,863 |
$700K |
| T4533 |
Youth size brief/diaper |
10,999 |
10,833 |
$697K |
| A4344 |
Cath indw foley 2 way silicn |
4,052 |
3,841 |
$640K |
| A4394 |
Ostomy pouch liq deodorant |
30,944 |
30,405 |
$565K |
| A4406 |
Pectin based ostomy paste |
27,056 |
26,596 |
$558K |
| A4338 |
Indwelling catheter latex |
13,787 |
13,266 |
$541K |
| A4456 |
Adhesive remover, wipes |
49,362 |
48,756 |
$511K |
| B4036 |
Enteral feed sup kit grav by |
8,233 |
7,942 |
$503K |
| A4390 |
Drainable pch ex wear convex |
2,245 |
2,134 |
$453K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
3,948 |
3,832 |
$451K |
| A4358 |
Urinary leg or abdomen bag |
22,051 |
21,418 |
$446K |
| B4087 |
Gastro/jejuno tube, std |
4,894 |
4,549 |
$443K |
| A5120 |
Skin barrier, wipe or swab |
55,459 |
54,658 |
$442K |
| A4419 |
Ost pch for bar w flange/flt |
5,062 |
4,938 |
$412K |
| A4310 |
Insert tray w/o bag/cath |
11,990 |
11,688 |
$363K |
| A4430 |
Ost urine pch w b/bltin conv |
1,889 |
1,799 |
$357K |
| A4432 |
Os pch urine w bar/fange/tap |
4,361 |
4,263 |
$354K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
5,411 |
5,193 |
$321K |
| A6021 |
Collagen dressing <=16 sq in |
1,226 |
1,186 |
$273K |
| A9900 |
Supply/accessory/service |
18,756 |
18,530 |
$271K |
| A4389 |
Drainable pch w st wear barr |
1,486 |
1,447 |
$269K |
| A6196 |
Alginate dressing <=16 sq in |
1,398 |
1,335 |
$267K |
| A4371 |
Skin barrier powder per oz |
29,040 |
28,532 |
$251K |
| A4520 |
Incontinence garment anytype |
17,551 |
14,940 |
$237K |
| A5062 |
Drnble ostomy pouch w/o barr |
1,604 |
1,596 |
$234K |
| A6454 |
Self-adher band w>=3" <5"/yd |
4,042 |
3,948 |
$229K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
2,577 |
2,486 |
$222K |
| B4155 |
Ef incomplete/modular |
3,280 |
3,135 |
$218K |
| T4536 |
Reusable pull-on any size |
20,333 |
20,098 |
$200K |
| E0776 |
Iv pole |
3,676 |
3,616 |
$192K |
| A4333 |
Urinary cath anchor device |
6,580 |
6,419 |
$192K |
| A6216 |
Non-sterile gauze<=16 sq in |
15,236 |
14,863 |
$187K |
| A6211 |
Foam drg > 48 sq in w/o brdr |
307 |
293 |
$181K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
5,135 |
5,003 |
$160K |
| A4402 |
Lubricant per ounce |
33,729 |
33,462 |
$147K |
| A4373 |
Skin barrier with flange |
1,139 |
1,074 |
$136K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
2,634 |
2,555 |
$136K |
| A4416 |
Ost pch clsd w barrier/filtr |
937 |
910 |
$120K |
| A5121 |
Solid skin barrier 6x6 |
802 |
780 |
$112K |
| A6240 |
Hydrocolld drg filler paste |
1,868 |
1,800 |
$110K |
| A4427 |
Ost pch drain/barr lk flng/f |
1,443 |
1,382 |
$96K |
| A4367 |
Ostomy belt |
12,911 |
12,717 |
$93K |
| A4320 |
Irrigation tray |
2,024 |
1,957 |
$84K |
| A5112 |
Urinary leg bag |
2,198 |
2,114 |
$84K |
| A4314 |
Cath w/drainage 2-way latex |
2,038 |
1,987 |
$82K |
| A6266 |
Impreg gauze no h20/sal/yard |
1,105 |
1,049 |
$79K |
| A4428 |
Urine ost pouch w faucet/tap |
517 |
505 |
$68K |
| E0603 |
Electric breast pump |
1,021 |
1,014 |
$67K |
| A4364 |
Adhesive, liquid or equal |
2,681 |
2,651 |
$65K |
| A6248 |
Hydrogel drsg gel filler |
975 |
928 |
$65K |
| A4239 |
Non-adju cgm supply allow |
796 |
794 |
$50K |
| A6199 |
Alginate drsg wound filler |
311 |
282 |
$49K |
| A6257 |
Transparent film <= 16 sq in |
5,000 |
4,874 |
$48K |
| A4217 |
Sterile water/saline, 500 ml |
568 |
549 |
$48K |
| B4034 |
Enter feed supkit syr by day |
1,625 |
1,564 |
$48K |
| A4455 |
Adhesive remover per ounce |
3,455 |
3,422 |
$45K |
| A5054 |
Clsd ostomy pouch w/flange |
600 |
579 |
$44K |
| A4332 |
Lube sterile packet |
2,756 |
2,704 |
$38K |
| B4082 |
Enteral ng tubing w/o stylet |
2,246 |
2,161 |
$36K |
| T4531 |
Ped size pull-on sm/med |
479 |
474 |
$33K |
| A6220 |
Gauze >16 <=48 sq in w/bordr |
283 |
265 |
$30K |
| A6235 |
Hydrocolld drg >16<=48 w/o b |
162 |
134 |
$29K |
| A6259 |
Transparent film > 48 sq in |
242 |
240 |
$29K |
| A4369 |
Skin barrier liquid per oz |
5,124 |
4,999 |
$27K |
| A9286 |
Any hygienic item, device |
6,146 |
5,982 |
$22K |
| A4412 |
Ost pouch drain high output |
164 |
163 |
$21K |
| A4405 |
Nonpectin based ostomy paste |
1,842 |
1,825 |
$20K |
| A6219 |
Gauze <= 16 sq in w/border |
379 |
361 |
$19K |
| A4331 |
Extension drainage tubing |
2,580 |
2,451 |
$17K |
| A5114 |
Foam/fabric leg strap |
1,257 |
1,232 |
$16K |
| A4452 |
Waterproof tape |
1,129 |
1,066 |
$14K |
| B4158 |
Ef ped complete intact nut |
114 |
112 |
$13K |
| B4081 |
Enteral ng tubing w/ stylet |
561 |
551 |
$13K |
| A4554 |
Disposable underpads |
107 |
106 |
$13K |
| A4393 |
Urine pch w ex wear bar conv |
38 |
37 |
$11K |
| A5131 |
Appliance cleaner |
1,133 |
1,124 |
$10K |
| A6403 |
Sterile gauze>16 <= 48 sq in |
179 |
174 |
$8K |
| A6258 |
Transparent film >16<=48 in |
48 |
44 |
$8K |
| A5055 |
Stoma cap |
125 |
123 |
$6K |
| A4657 |
Syringe w/wo needle |
3,641 |
3,000 |
$6K |
| A6449 |
Lt compres band >=3" <5"/yd |
89 |
82 |
$5K |
| A6022 |
Collagen drsg>16<=48 sq in |
28 |
24 |
$5K |
| A6445 |
Conform band s w <3"/yd |
248 |
233 |
$5K |
| A4450 |
Non-waterproof tape |
1,048 |
988 |
$3K |
| A5073 |
Urinary pouch on barr w/flng |
40 |
38 |
$3K |
| A6407 |
Packing strips, non-impreg |
105 |
97 |
$3K |
| A4311 |
Catheter w/o bag 2-way latex |
167 |
152 |
$3K |
| A9270 |
Non-covered item or service |
384 |
343 |
$2K |
| A9999 |
Dme supply or accessory, nos |
43 |
39 |
$2K |
| A6260 |
Wound cleanser any type/size |
288 |
282 |
$1K |
| E2103 |
Non-adju cgm receiver/mon |
13 |
13 |
$1K |
| A6457 |
Tubular dressing |
13 |
12 |
$1K |
| A4363 |
Ostomy clamp, replacement |
98 |
97 |
$909.89 |
| A4354 |
Cath insertion tray w/bag |
14 |
14 |
$309.93 |
| A4245 |
Alcohol wipes per box |
144 |
139 |
$295.98 |