| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Large disposable underpad |
5,120 |
5,118 |
$268K |
| T4527 |
Adult size pull-on lg |
2,016 |
2,016 |
$145K |
| T4523 |
Adult size brief/diaper lg |
1,253 |
1,253 |
$141K |
| T4531 |
Ped size pull-on sm/med |
578 |
578 |
$101K |
| A6197 |
Alginate drsg >16 <=48 sq in |
178 |
178 |
$97K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
176 |
169 |
$63K |
| A6446 |
Conform band s w>=3" <5"/yd |
1,126 |
1,120 |
$47K |
| A6402 |
Sterile gauze <= 16 sq in |
1,807 |
1,793 |
$46K |
| A4217 |
Sterile water/saline, 500 ml |
523 |
511 |
$37K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
201 |
201 |
$29K |
| T4526 |
Adult size pull-on med |
477 |
477 |
$27K |
| T4532 |
Ped size pull-on lg |
84 |
84 |
$15K |
| T4528 |
Adult size pull-on xl |
178 |
178 |
$13K |
| A6403 |
Sterile gauze>16 <= 48 sq in |
258 |
258 |
$11K |
| T4524 |
Adult size brief/diaper xl |
114 |
114 |
$11K |
| A6454 |
Self-adher band w>=3" <5"/yd |
442 |
439 |
$11K |
| A4406 |
Pectin based ostomy paste |
402 |
322 |
$9K |
| A4450 |
Non-waterproof tape |
410 |
403 |
$7K |
| A4338 |
Indwelling catheter latex |
54 |
41 |
$5K |
| A4927 |
Non-sterile gloves |
269 |
269 |
$5K |
| A5120 |
Skin barrier, wipe or swab |
395 |
393 |
$3K |
| A4456 |
Adhesive remover, wipes |
342 |
342 |
$3K |
| A6404 |
Sterile gauze > 48 sq in |
41 |
41 |
$2K |
| A4357 |
Bedside drainage bag |
53 |
41 |
$1K |
| A4358 |
Urinary leg or abdomen bag |
27 |
26 |
$1K |
| A4310 |
Insert tray w/o bag/cath |
28 |
27 |
$721.60 |
| A6216 |
Non-sterile gauze<=16 sq in |
55 |
55 |
$602.50 |