| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
35,173 |
34,473 |
$17.63M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
47,442 |
46,686 |
$7.99M |
| T4534 |
Youth size pull-on |
26,564 |
26,379 |
$3.49M |
| T4530 |
Ped size brief/diaper lg |
22,911 |
22,630 |
$2.80M |
| B4154 |
Ef spec metabolic noninherit |
18,208 |
18,016 |
$2.08M |
| T4532 |
Ped size pull-on lg |
14,449 |
14,307 |
$2.00M |
| B4150 |
Ef complet w/intact nutrient |
15,894 |
15,746 |
$1.97M |
| B4152 |
Ef calorie dense>/=1.5kcal |
14,039 |
13,933 |
$1.79M |
| T4535 |
Disposable liner/shield/pad |
20,991 |
20,530 |
$1.16M |
| T4522 |
Adult size brief/diaper med |
12,065 |
11,929 |
$1.16M |
| T4541 |
Large disposable underpad |
27,150 |
26,832 |
$1.00M |
| T4526 |
Adult size pull-on med |
11,424 |
11,342 |
$980K |
| B4158 |
Ef ped complete intact nut |
2,754 |
2,689 |
$878K |
| T4523 |
Adult size brief/diaper lg |
7,681 |
7,526 |
$863K |
| T4527 |
Adult size pull-on lg |
8,153 |
8,092 |
$739K |
| T4521 |
Adult size brief/diaper sm |
5,019 |
4,970 |
$597K |
| T4528 |
Adult size pull-on xl |
4,770 |
4,728 |
$510K |
| T4525 |
Adult size pull-on sm |
4,278 |
4,191 |
$477K |
| T4533 |
Youth size brief/diaper |
4,410 |
4,351 |
$477K |
| A4927 |
Non-sterile gloves |
17,991 |
17,877 |
$452K |
| T4524 |
Adult size brief/diaper xl |
2,628 |
2,571 |
$329K |
| T4537 |
Reusable underpad bed size |
14,845 |
14,689 |
$244K |
| T4544 |
Adlt disp und/pull on abv xl |
1,529 |
1,466 |
$244K |
| A4351 |
Straight tip urine catheter |
1,924 |
1,797 |
$220K |
| B4100 |
Food thickener oral |
1,716 |
1,679 |
$216K |
| A9901 |
Delivery/set up/dispensing |
70,574 |
67,378 |
$188K |
| B4155 |
Ef incomplete/modular |
2,864 |
2,825 |
$184K |
| T4543 |
Adult disp brief/diap abv xl |
643 |
634 |
$140K |
| T4531 |
Ped size pull-on sm/med |
1,172 |
1,166 |
$133K |
| B4102 |
Ef adult fluids and electro |
1,524 |
1,495 |
$119K |
| A4670 |
Automatic bp monitor, dial |
1,644 |
1,641 |
$87K |
| E0245 |
Tub stool or bench |
1,284 |
1,282 |
$49K |
| B9998 |
Enteral supp not otherwise c |
145 |
145 |
$22K |
| B4103 |
Ef ped fluid and electrolyte |
265 |
257 |
$22K |
| E0143 |
Walker folding wheeled w/o s |
182 |
182 |
$5K |
| A4357 |
Bedside drainage bag |
403 |
397 |
$2K |
| A4210 |
Nonneedle injection device |
27 |
27 |
$1K |
| E0156 |
Walker seat attachment |
143 |
143 |
$1K |
| A4349 |
Disposable male external cat |
14 |
12 |
$973.87 |
| E0100 |
Cane adjust/fixed with tip |
28 |
28 |
$415.47 |
| A4358 |
Urinary leg or abdomen bag |
13 |
12 |
$72.05 |