| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
9,920 |
9,160 |
$5.26M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
12,138 |
11,434 |
$2.62M |
| A4351 |
Straight tip urine catheter |
2,420 |
1,602 |
$1.03M |
| T4534 |
Youth size pull-on |
8,327 |
7,891 |
$718K |
| T5999 |
Supply, nos |
6,054 |
5,695 |
$646K |
| B9998 |
Enteral supp not otherwise c |
4,961 |
3,537 |
$625K |
| T4526 |
Adult size pull-on med |
6,278 |
5,917 |
$518K |
| T4527 |
Adult size pull-on lg |
5,071 |
4,807 |
$443K |
| T4530 |
Ped size brief/diaper lg |
3,202 |
3,062 |
$369K |
| T4528 |
Adult size pull-on xl |
3,693 |
3,437 |
$327K |
| T4535 |
Disposable liner/shield/pad |
10,132 |
9,489 |
$314K |
| B4150 |
Ef complet w/intact nutrient |
2,076 |
1,907 |
$281K |
| T4541 |
Large disposable underpad |
12,657 |
11,736 |
$273K |
| B4100 |
Food thickener oral |
1,930 |
1,783 |
$255K |
| A4927 |
Non-sterile gloves |
10,356 |
9,338 |
$230K |
| T4523 |
Adult size brief/diaper lg |
2,278 |
2,145 |
$193K |
| T4522 |
Adult size brief/diaper med |
2,638 |
2,447 |
$163K |
| B4035 |
Enteral feed supp pump per d |
698 |
575 |
$153K |
| A4335 |
Incontinence supply |
354 |
285 |
$124K |
| A4649 |
Surgical supplies |
340 |
168 |
$68K |
| A4357 |
Bedside drainage bag |
2,693 |
1,643 |
$53K |
| B4158 |
Ef ped complete intact nut |
169 |
140 |
$49K |
| T4533 |
Youth size brief/diaper |
651 |
615 |
$44K |
| T4537 |
Reusable underpad bed size |
2,600 |
2,491 |
$42K |
| T4521 |
Adult size brief/diaper sm |
429 |
349 |
$31K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
385 |
246 |
$24K |
| T4544 |
Adlt disp und/pull on abv xl |
218 |
206 |
$22K |
| B4152 |
Ef calorie dense>/=1.5kcal |
143 |
136 |
$18K |
| A9286 |
Any hygienic item, device |
596 |
578 |
$16K |
| T4524 |
Adult size brief/diaper xl |
201 |
198 |
$16K |
| B4155 |
Ef incomplete/modular |
124 |
105 |
$10K |
| A4322 |
Irrigation syringe |
228 |
197 |
$9K |
| A5120 |
Skin barrier, wipe or swab |
1,215 |
881 |
$5K |
| A4452 |
Waterproof tape |
201 |
144 |
$4K |
| A4456 |
Adhesive remover, wipes |
683 |
521 |
$4K |
| A6212 |
Foam drg <=16 sq in w/border |
12 |
12 |
$2K |
| A4358 |
Urinary leg or abdomen bag |
394 |
225 |
$2K |
| T4543 |
Adult disp brief/diap abv xl |
12 |
12 |
$2K |