| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
22,049 |
20,867 |
$1.40M |
| T4527 |
Adult size pull-on lg |
5,213 |
4,965 |
$1.09M |
| T4535 |
Disposable liner/shield/pad |
9,896 |
9,233 |
$773K |
| T4526 |
Adult size pull-on med |
4,326 |
4,050 |
$731K |
| T4528 |
Adult size pull-on xl |
3,206 |
2,986 |
$606K |
| A4927 |
Non-sterile gloves |
23,204 |
21,884 |
$510K |
| B4150 |
Ef complet w/intact nutrient |
4,316 |
4,017 |
$468K |
| A6212 |
Foam drg <=16 sq in w/border |
915 |
897 |
$203K |
| T4544 |
Adlt disp und/pull on abv xl |
645 |
630 |
$194K |
| T4523 |
Adult size brief/diaper lg |
1,015 |
939 |
$160K |
| T4522 |
Adult size brief/diaper med |
1,092 |
983 |
$157K |
| A6250 |
Skin seal protect moisturizr |
15,819 |
14,860 |
$144K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
699 |
685 |
$124K |
| E1390 |
Oxygen concentrator |
2,328 |
2,018 |
$121K |
| A6197 |
Alginate drsg >16 <=48 sq in |
150 |
146 |
$99K |
| B4152 |
Ef calorie dense>/=1.5kcal |
531 |
508 |
$74K |
| T4534 |
Youth size pull-on |
281 |
279 |
$69K |
| T4525 |
Adult size pull-on sm |
511 |
471 |
$64K |
| T5999 |
Supply, nos |
945 |
830 |
$62K |
| B4154 |
Ef spec metabolic noninherit |
160 |
151 |
$41K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,120 |
1,008 |
$40K |
| A6402 |
Sterile gauze <= 16 sq in |
1,642 |
1,502 |
$34K |
| A6216 |
Non-sterile gauze<=16 sq in |
1,864 |
1,769 |
$30K |
| A4351 |
Straight tip urine catheter |
385 |
369 |
$28K |
| A6260 |
Wound cleanser any type/size |
874 |
867 |
$27K |
| A6446 |
Conform band s w>=3" <5"/yd |
753 |
687 |
$27K |
| A4357 |
Bedside drainage bag |
3,276 |
3,163 |
$24K |
| A4452 |
Waterproof tape |
1,275 |
1,250 |
$23K |
| A4217 |
Sterile water/saline, 500 ml |
2,690 |
2,168 |
$22K |
| K0001 |
Standard wheelchair |
830 |
737 |
$18K |
| A4338 |
Indwelling catheter latex |
1,919 |
1,878 |
$17K |
| E0431 |
Portable gaseous 02 |
1,382 |
1,088 |
$15K |
| A4245 |
Alcohol wipes per box |
1,479 |
1,448 |
$14K |
| A4310 |
Insert tray w/o bag/cath |
2,480 |
2,413 |
$14K |
| A4358 |
Urinary leg or abdomen bag |
2,010 |
1,975 |
$11K |
| A4331 |
Extension drainage tubing |
2,083 |
2,034 |
$9K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
37 |
36 |
$8K |
| A5120 |
Skin barrier, wipe or swab |
722 |
674 |
$6K |
| A4500 |
Below knee surgical stocking |
288 |
281 |
$6K |
| E0442 |
Stationary o2 contents, liq |
152 |
149 |
$6K |
| A4450 |
Non-waterproof tape |
859 |
794 |
$5K |
| A6248 |
Hydrogel drsg gel filler |
92 |
87 |
$5K |
| A4320 |
Irrigation tray |
1,060 |
1,035 |
$5K |
| E0434 |
Portable liquid 02 |
150 |
147 |
$4K |
| A4402 |
Lubricant per ounce |
1,459 |
1,424 |
$4K |
| A4670 |
Automatic bp monitor, dial |
56 |
26 |
$2K |
| E0325 |
Urinal male jug-type |
739 |
691 |
$2K |
| T4524 |
Adult size brief/diaper xl |
14 |
14 |
$2K |
| E0570 |
Nebulizer with compression |
72 |
59 |
$2K |
| A4322 |
Irrigation syringe |
95 |
85 |
$2K |
| A4334 |
Urinary cath leg strap |
316 |
253 |
$1K |
| A7003 |
Nebulizer administration set |
335 |
319 |
$522.07 |
| A4520 |
Incontinence garment anytype |
85 |
65 |
$0.00 |