| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4161 |
Ef ped hydrolyzed/amino acid |
10,195 |
9,288 |
$8.80M |
| A4554 |
Disposable underpads |
7,154 |
6,955 |
$1.10M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
1,867 |
1,745 |
$548K |
| T4533 |
Youth size brief/diaper |
3,093 |
2,960 |
$306K |
| B4035 |
Enteral feed supp pump per d |
1,008 |
966 |
$257K |
| T4537 |
Reusable underpad bed size |
2,929 |
2,839 |
$175K |
| T4530 |
Ped size brief/diaper lg |
1,499 |
1,445 |
$139K |
| T4522 |
Adult size brief/diaper med |
583 |
570 |
$71K |
| T4523 |
Adult size brief/diaper lg |
394 |
381 |
$59K |
| T4535 |
Disposable liner/shield/pad |
649 |
645 |
$23K |
| A9286 |
Any hygienic item, device |
528 |
525 |
$19K |
| T4524 |
Adult size brief/diaper xl |
120 |
117 |
$19K |
| T4527 |
Adult size pull-on lg |
143 |
143 |
$17K |
| V5266 |
Battery for hearing device |
602 |
289 |
$17K |
| T4534 |
Youth size pull-on |
118 |
117 |
$15K |
| A4928 |
Surgical mask |
74 |
70 |
$10K |
| A4322 |
Irrigation syringe |
231 |
221 |
$9K |
| A4657 |
Syringe w/wo needle |
159 |
152 |
$9K |
| B9002 |
Enter nutr inf pump any type |
36 |
36 |
$7K |
| T4526 |
Adult size pull-on med |
62 |
61 |
$6K |
| A4927 |
Non-sterile gloves |
2,989 |
2,957 |
$5K |
| A6402 |
Sterile gauze <= 16 sq in |
360 |
340 |
$3K |
| B4088 |
Gastro/jejuno tube, low-pro |
67 |
66 |
$3K |
| T4539 |
Reuse diaper/brief any size |
36 |
36 |
$2K |
| T4521 |
Adult size brief/diaper sm |
13 |
12 |
$2K |
| A4452 |
Waterproof tape |
50 |
49 |
$451.35 |