| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4160 |
Ef ped caloric dense>/=0.7kc |
38,202 |
36,782 |
$8.55M |
| B4161 |
Ef ped hydrolyzed/amino acid |
8,468 |
7,917 |
$4.72M |
| B4035 |
Enteral feed supp pump per d |
19,762 |
18,419 |
$4.31M |
| B4150 |
Ef complet w/intact nutrient |
37,493 |
35,058 |
$3.77M |
| A6197 |
Alginate drsg >16 <=48 sq in |
13,601 |
11,887 |
$3.48M |
| A6212 |
Foam drg <=16 sq in w/border |
20,269 |
17,566 |
$2.44M |
| A6253 |
Absorpt drg > 48 sq in w/o b |
15,063 |
13,312 |
$2.36M |
| B4152 |
Ef calorie dense>/=1.5kcal |
16,824 |
15,956 |
$2.12M |
| B9998 |
Enteral supp not otherwise c |
20,948 |
17,009 |
$2.08M |
| A6021 |
Collagen dressing <=16 sq in |
8,647 |
7,844 |
$1.91M |
| B4154 |
Ef spec metabolic noninherit |
12,388 |
11,595 |
$1.71M |
| T4527 |
Adult size pull-on lg |
22,517 |
22,237 |
$1.56M |
| A6196 |
Alginate dressing <=16 sq in |
13,628 |
12,163 |
$1.47M |
| T4526 |
Adult size pull-on med |
21,826 |
21,456 |
$1.40M |
| B4153 |
Ef hydrolyzed/amino acids |
1,895 |
1,750 |
$1.36M |
| T4541 |
Large disposable underpad |
60,441 |
59,248 |
$1.28M |
| B4088 |
Gastro/jejuno tube, low-pro |
10,596 |
10,216 |
$1.26M |
| T4528 |
Adult size pull-on xl |
16,271 |
15,991 |
$1.25M |
| T4534 |
Youth size pull-on |
14,608 |
13,663 |
$1.11M |
| B9002 |
Enter nutr inf pump any type |
17,531 |
16,298 |
$1.04M |
| A4353 |
Intermittent urinary cath |
1,867 |
1,775 |
$1.01M |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
15,654 |
14,181 |
$983K |
| E1399 |
Durable medical equipment mi |
2,824 |
2,146 |
$913K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
4,069 |
3,710 |
$862K |
| A4351 |
Straight tip urine catheter |
7,137 |
6,803 |
$848K |
| A6446 |
Conform band s w>=3" <5"/yd |
34,520 |
30,700 |
$848K |
| T4523 |
Adult size brief/diaper lg |
10,127 |
9,878 |
$756K |
| T4543 |
Adult disp brief/diap abv xl |
3,330 |
3,263 |
$686K |
| B4149 |
Ef blenderized foods |
1,629 |
1,514 |
$589K |
| A4927 |
Non-sterile gloves |
48,369 |
45,731 |
$554K |
| T4544 |
Adlt disp und/pull on abv xl |
4,141 |
4,049 |
$554K |
| T4522 |
Adult size brief/diaper med |
7,790 |
7,611 |
$553K |
| A4409 |
Ost skn barr convex <=4 sq i |
7,481 |
7,144 |
$532K |
| L4361 |
Pneuma/vac walk boot pre ots |
2,508 |
2,472 |
$484K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
9,706 |
8,739 |
$481K |
| A4385 |
Ost skn barrier sld ext wear |
7,466 |
7,095 |
$452K |
| T4524 |
Adult size brief/diaper xl |
5,957 |
5,814 |
$449K |
| E0570 |
Nebulizer with compression |
6,197 |
6,098 |
$441K |
| T4530 |
Ped size brief/diaper lg |
6,322 |
5,925 |
$431K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
7,880 |
7,277 |
$397K |
| A4452 |
Waterproof tape |
36,653 |
32,872 |
$392K |
| A4216 |
Sterile water/saline, 10 ml |
34,725 |
32,091 |
$391K |
| A4425 |
Ost pch drain for barrier fl |
8,417 |
8,045 |
$369K |
| T4537 |
Reusable underpad bed size |
10,190 |
9,990 |
$367K |
| B4155 |
Ef incomplete/modular |
5,803 |
5,444 |
$367K |
| T4532 |
Ped size pull-on lg |
5,021 |
4,762 |
$329K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
3,392 |
3,099 |
$289K |
| T4535 |
Disposable liner/shield/pad |
10,168 |
9,916 |
$284K |
| A4407 |
Ext wear ost skn barr <=4sq" |
2,805 |
2,667 |
$280K |
| T4525 |
Adult size pull-on sm |
4,375 |
4,261 |
$250K |
| A6199 |
Alginate drsg wound filler |
1,968 |
1,779 |
$226K |
| A4239 |
Non-adju cgm supply allow |
2,361 |
2,220 |
$224K |
| A6402 |
Sterile gauze <= 16 sq in |
34,219 |
31,111 |
$223K |
| A6452 |
High compres band w>=3"<5"yd |
1,777 |
1,446 |
$217K |
| A6216 |
Non-sterile gauze<=16 sq in |
29,094 |
26,962 |
$210K |
| A4670 |
Automatic bp monitor, dial |
3,914 |
3,836 |
$199K |
| A4322 |
Irrigation syringe |
7,149 |
6,673 |
$194K |
| B4158 |
Ef ped complete intact nut |
1,029 |
983 |
$184K |
| L1833 |
Ko adj jnt pos r sup pre ots |
413 |
394 |
$178K |
| A6258 |
Transparent film >16<=48 in |
2,573 |
2,136 |
$174K |
| A5056 |
1 pc ost pouch w filter |
2,830 |
2,710 |
$168K |
| A6449 |
Lt compres band >=3" <5"/yd |
6,099 |
5,437 |
$166K |
| B4034 |
Enter feed supkit syr by day |
1,734 |
1,545 |
$162K |
| B4100 |
Food thickener oral |
3,453 |
3,386 |
$147K |
| A6203 |
Composite drsg <= 16 sq in |
1,844 |
1,709 |
$135K |
| B4036 |
Enteral feed sup kit grav by |
1,507 |
1,352 |
$133K |
| A4314 |
Cath w/drainage 2-way latex |
11,295 |
10,885 |
$132K |
| B4103 |
Ef ped fluid and electrolyte |
2,285 |
2,171 |
$125K |
| A4352 |
Coude tip urinary catheter |
686 |
654 |
$121K |
| E0260 |
Hosp bed semi-electr w/ matt |
2,734 |
2,669 |
$115K |
| A6217 |
Non-sterile gauze>16<=48 sq |
1,589 |
1,464 |
$109K |
| A6219 |
Gauze <= 16 sq in w/border |
7,004 |
6,290 |
$106K |
| K0553 |
Ther cgm supply allowance |
1,048 |
992 |
$102K |
| A6450 |
Lt compres band >=5"/yd |
1,238 |
1,127 |
$101K |
| A5057 |
1 pc ost pou w built-in conv |
1,027 |
978 |
$100K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
1,434 |
1,381 |
$95K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
2,374 |
2,216 |
$94K |
| A4624 |
Tracheal suction tube |
1,661 |
1,287 |
$94K |
| E1390 |
Oxygen concentrator |
1,017 |
992 |
$84K |
| A4394 |
Ostomy pouch liq deodorant |
5,956 |
5,745 |
$82K |
| L3908 |
Who cock-up nonmolde pre ots |
1,969 |
1,558 |
$78K |
| L3809 |
Whfo w/o joints pre ots |
502 |
480 |
$74K |
| A4362 |
Solid skin barrier |
4,863 |
4,616 |
$73K |
| A4357 |
Bedside drainage bag |
11,106 |
10,724 |
$71K |
| A6207 |
Contact layer >16<= 48 sq in |
1,089 |
959 |
$69K |
| A6243 |
Hydrogel drg >16<=48 w/o bdr |
433 |
401 |
$65K |
| A6266 |
Impreg gauze no h20/sal/yard |
1,184 |
1,094 |
$65K |
| A6545 |
Grad com non-elastic bk surg |
1,034 |
890 |
$65K |
| A4349 |
Disposable male external cat |
3,148 |
3,016 |
$65K |
| A4410 |
Ost skn barr extnd >4 sq |
632 |
612 |
$63K |
| A5120 |
Skin barrier, wipe or swab |
13,394 |
12,875 |
$62K |
| T4521 |
Adult size brief/diaper sm |
962 |
900 |
$60K |
| A4456 |
Adhesive remover, wipes |
8,073 |
7,769 |
$55K |
| A6010 |
Collagen based wound filler |
286 |
241 |
$55K |
| A4419 |
Ost pch for bar w flange/flt |
988 |
961 |
$54K |
| A4432 |
Os pch urine w bar/fange/tap |
1,212 |
1,179 |
$53K |
| K0001 |
Standard wheelchair |
2,848 |
2,780 |
$48K |
| A6456 |
Zinc paste band w >=3"<5"/yd |
1,396 |
1,215 |
$48K |
| L1902 |
Afo ankle gauntlet pre ots |
861 |
839 |
$47K |
| A6240 |
Hydrocolld drg filler paste |
1,944 |
1,775 |
$46K |
| B9999 |
Parenteral supp not othrws c |
271 |
269 |
$45K |
| A6454 |
Self-adher band w>=3" <5"/yd |
3,056 |
2,655 |
$42K |
| A5063 |
Drain ostomy pouch w/flange |
1,130 |
1,040 |
$42K |
| E0445 |
Oximeter non-invasive |
336 |
330 |
$39K |
| E0776 |
Iv pole |
3,349 |
3,237 |
$39K |
| A4333 |
Urinary cath anchor device |
6,061 |
5,841 |
$38K |
| A4358 |
Urinary leg or abdomen bag |
9,113 |
8,831 |
$35K |
| A6248 |
Hydrogel drsg gel filler |
957 |
880 |
$34K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
351 |
290 |
$33K |
| A4253 |
Blood glucose/reagent strips |
1,110 |
1,104 |
$31K |
| L3670 |
So acro/clav can web pre ots |
354 |
352 |
$30K |
| A4406 |
Pectin based ostomy paste |
4,902 |
4,693 |
$30K |
| A4320 |
Irrigation tray |
5,681 |
5,498 |
$29K |
| E0277 |
Powered pres-redu air mattrs |
236 |
229 |
$29K |
| E0143 |
Walker folding wheeled w/o s |
736 |
726 |
$27K |
| A6407 |
Packing strips, non-impreg |
2,233 |
1,966 |
$27K |
| B4102 |
Ef adult fluids and electro |
408 |
365 |
$27K |
| A6457 |
Tubular dressing |
2,496 |
2,118 |
$26K |
| A6445 |
Conform band s w <3"/yd |
1,422 |
1,350 |
$23K |
| A6441 |
Pad band w>=3" <5"/yd |
2,290 |
1,806 |
$22K |
| E0240 |
Bath/shower chair |
844 |
829 |
$22K |
| A4315 |
Cath w/drainage 2-way silcne |
1,131 |
1,094 |
$18K |
| A4450 |
Non-waterproof tape |
6,793 |
6,231 |
$17K |
| L1820 |
Ko elas w/ condyle pads & jo |
309 |
297 |
$16K |
| A7000 |
Disposable canister for pump |
2,356 |
2,289 |
$16K |
| A4427 |
Ost pch drain/barr lk flng/f |
547 |
524 |
$16K |
| A7003 |
Nebulizer administration set |
6,235 |
6,044 |
$15K |
| E0163 |
Commode chair with fixed arm |
474 |
463 |
$15K |
| E0431 |
Portable gaseous 02 |
994 |
981 |
$14K |
| A4628 |
Oropharyngeal suction cath |
1,346 |
1,291 |
$14K |
| A4332 |
Lube sterile packet |
2,612 |
2,489 |
$14K |
| A4217 |
Sterile water/saline, 500 ml |
307 |
293 |
$13K |
| E0630 |
Patient lift hydraulic |
407 |
395 |
$13K |
| A4371 |
Skin barrier powder per oz |
4,792 |
4,609 |
$12K |
| A7002 |
Tubing used w suction pump |
2,483 |
2,350 |
$12K |
| T4533 |
Youth size brief/diaper |
159 |
155 |
$12K |
| A6022 |
Collagen drsg>16<=48 sq in |
94 |
82 |
$12K |
| A6530 |
Compression stocking bk18-30 |
203 |
196 |
$11K |
| A6403 |
Sterile gauze>16 <= 48 sq in |
920 |
716 |
$11K |
| A4367 |
Ostomy belt |
2,450 |
2,361 |
$11K |
| A6443 |
Conform band n/s w>=3"<5"/yd |
1,306 |
1,161 |
$11K |
| A4334 |
Urinary cath leg strap |
3,775 |
3,667 |
$11K |
| A6257 |
Transparent film <= 16 sq in |
1,068 |
1,022 |
$10K |
| A4623 |
Tracheostomy inner cannula |
67 |
65 |
$10K |
| A4398 |
Ostomy irrigation bag |
972 |
951 |
$10K |
| L0621 |
Sio flex pelvic/sacr pre ots |
193 |
190 |
$9K |
| A6251 |
Absorpt drg <=16 sq in w/o b |
308 |
293 |
$9K |
| A4402 |
Lubricant per ounce |
2,280 |
2,097 |
$9K |
| E0265 |
Hosp bed total electr w/ mat |
93 |
91 |
$9K |
| E0973 |
W/ch access det adj armrest |
1,138 |
1,092 |
$9K |
| A4311 |
Catheter w/o bag 2-way latex |
849 |
833 |
$9K |
| E0600 |
Suction pump portab hom modl |
380 |
374 |
$9K |
| E0635 |
Patient lift electric |
121 |
116 |
$9K |
| A4310 |
Insert tray w/o bag/cath |
431 |
409 |
$9K |
| A6259 |
Transparent film > 48 sq in |
49 |
38 |
$8K |
| A6242 |
Hydrogel drg <=16 in w/o bdr |
118 |
109 |
$8K |
| A7015 |
Aerosol mask used w nebulize |
6,106 |
5,908 |
$8K |
| A4554 |
Disposable underpads |
434 |
427 |
$8K |
| A4399 |
Ostomy irrig cone/cath w brs |
985 |
965 |
$8K |
| E0978 |
W/c acc,saf belt pelv strap |
422 |
410 |
$7K |
| B4087 |
Gastro/jejuno tube, std |
303 |
298 |
$7K |
| E0114 |
Crutch underarm pair no wood |
186 |
185 |
$7K |
| A4259 |
Lancets per box |
1,058 |
1,053 |
$6K |
| E0156 |
Walker seat attachment |
808 |
795 |
$6K |
| K0195 |
Elevating whlchair leg rests |
753 |
724 |
$6K |
| E0303 |
Hosp bed hvy dty xtra wide |
71 |
70 |
$6K |
| E0149 |
Heavy duty wheeled walker |
75 |
69 |
$5K |
| A4424 |
Ost pch drain w bar & filter |
75 |
74 |
$5K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
353 |
343 |
$4K |
| A4213 |
20+ cc syringe only |
1,874 |
1,377 |
$4K |
| E0100 |
Cane adjust/fixed with tip |
341 |
335 |
$3K |
| E0304 |
Hosp bed xtra hvy dty x wide |
12 |
12 |
$3K |
| K0739 |
Repair/svc dme non-oxygen eq |
109 |
107 |
$3K |
| A9270 |
Non-covered item or service |
113 |
107 |
$3K |
| A4389 |
Drainable pch w st wear barr |
37 |
36 |
$3K |
| A6531 |
Compress stking bk30-40 surg |
44 |
38 |
$2K |
| A4373 |
Skin barrier with flange |
29 |
26 |
$2K |
| A7014 |
Compressor nondispos filter |
996 |
941 |
$2K |
| A7526 |
Tracheostomy tube collar |
94 |
91 |
$2K |
| E1238 |
Fld ped wc adjstabl w/o seat |
14 |
13 |
$2K |
| E0720 |
Tens two lead |
13 |
12 |
$2K |
| K0006 |
Heavy duty wheelchair |
43 |
43 |
$2K |
| L4397 |
Static or dynami afo pre ots |
13 |
13 |
$2K |
| A4629 |
Tracheostomy care kit |
16 |
13 |
$2K |
| A4338 |
Indwelling catheter latex |
64 |
62 |
$2K |
| A4660 |
Sphyg/bp app w cuff and stet |
60 |
60 |
$1K |
| A4397 |
Irrigation supply sleeve |
90 |
89 |
$1K |
| A7005 |
Nondisposable nebulizer set |
69 |
67 |
$1K |
| B4081 |
Enteral ng tubing w/ stylet |
30 |
24 |
$1K |
| L3660 |
So 8 ab rstr can/web pre ots |
12 |
12 |
$980.43 |
| E2103 |
Non-adju cgm receiver/mon |
16 |
12 |
$891.25 |
| A4606 |
Oxygen probe used w oximeter |
38 |
37 |
$743.43 |
| A6447 |
Conform band s w >=5"/yd |
25 |
25 |
$720.67 |
| L4350 |
Ankle control ortho pre ots |
12 |
12 |
$702.28 |
| E0181 |
Press pad alternating w/ pum |
88 |
88 |
$675.44 |
| A5061 |
Pouch drainable w barrier at |
12 |
12 |
$671.91 |
| A6224 |
Gauze > 48 in no w/sal w/o b |
17 |
13 |
$579.69 |
| A5500 |
Diab shoe for density insert |
12 |
12 |
$568.90 |
| A4340 |
Indwelling catheter special |
67 |
64 |
$463.99 |
| A4209 |
5+ cc sterile syringe&needle |
147 |
143 |
$397.44 |
| E0147 |
Walker variable wheel resist |
13 |
13 |
$391.06 |
| K0052 |
Swingaway detach ftrest repl |
77 |
74 |
$199.33 |
| A4245 |
Alcohol wipes per box |
107 |
106 |
$190.12 |
| E0971 |
Wheelchair anti-tipping devi |
25 |
25 |
$91.19 |