| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2028 |
Special supply, nos waiver |
29,833 |
26,776 |
$7.24M |
| A4253 |
Blood glucose/reagent strips |
53,737 |
50,506 |
$6.34M |
| T4527 |
Adult size pull-on lg |
52,735 |
48,100 |
$4.80M |
| T4526 |
Adult size pull-on med |
47,426 |
43,468 |
$4.01M |
| A4554 |
Disposable underpads |
122,332 |
113,518 |
$3.36M |
| T4528 |
Adult size pull-on xl |
37,355 |
34,398 |
$3.34M |
| T4535 |
Disposable liner/shield/pad |
65,760 |
61,007 |
$3.33M |
| T4532 |
Ped size pull-on lg |
26,629 |
24,319 |
$2.88M |
| A4239 |
Non-adju cgm supply allow |
12,182 |
10,335 |
$2.58M |
| A9999 |
Dme supply or accessory, nos |
4,402 |
3,684 |
$2.38M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
10,319 |
9,044 |
$1.71M |
| A4927 |
Non-sterile gloves |
136,516 |
126,594 |
$1.65M |
| T4544 |
Adlt disp und/pull on abv xl |
15,529 |
14,445 |
$1.46M |
| T4523 |
Adult size brief/diaper lg |
14,436 |
12,663 |
$1.43M |
| T4522 |
Adult size brief/diaper med |
14,439 |
12,437 |
$1.29M |
| A4259 |
Lancets per box |
49,856 |
47,067 |
$1.14M |
| K0553 |
Ther cgm supply allowance |
5,226 |
4,655 |
$1.07M |
| T4531 |
Ped size pull-on sm/med |
8,645 |
7,981 |
$810K |
| B4150 |
Ef complet w/intact nutrient |
5,716 |
4,847 |
$809K |
| B4100 |
Food thickener oral |
5,397 |
4,701 |
$764K |
| A4351 |
Straight tip urine catheter |
5,792 |
4,946 |
$687K |
| T4524 |
Adult size brief/diaper xl |
6,615 |
5,693 |
$627K |
| T4530 |
Ped size brief/diaper lg |
5,262 |
4,783 |
$534K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
6,722 |
5,855 |
$451K |
| T4525 |
Adult size pull-on sm |
6,028 |
5,560 |
$432K |
| A4425 |
Ost pch drain for barrier fl |
5,206 |
4,588 |
$337K |
| E0240 |
Bath/shower chair |
1,858 |
1,543 |
$309K |
| T4521 |
Adult size brief/diaper sm |
3,187 |
2,776 |
$265K |
| B4161 |
Ef ped hydrolyzed/amino acid |
674 |
498 |
$255K |
| E0607 |
Blood glucose monitor home |
3,756 |
3,177 |
$238K |
| A6216 |
Non-sterile gauze<=16 sq in |
5,377 |
4,764 |
$225K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,940 |
1,505 |
$225K |
| A9276 |
Disposable sensor, cgm sys |
1,145 |
1,037 |
$213K |
| T4543 |
Adult disp brief/diap abv xl |
2,239 |
2,044 |
$209K |
| E0246 |
Transfer tub rail attachment |
2,645 |
2,097 |
$199K |
| A9277 |
External transmitter, cgm |
396 |
364 |
$136K |
| T4534 |
Youth size pull-on |
1,639 |
1,542 |
$133K |
| B9998 |
Enteral supp not otherwise c |
3,376 |
2,705 |
$124K |
| E2103 |
Non-adju cgm receiver/mon |
477 |
396 |
$107K |
| A4362 |
Solid skin barrier |
2,716 |
2,295 |
$105K |
| B4035 |
Enteral feed supp pump per d |
2,791 |
1,063 |
$104K |
| A5056 |
1 pc ost pouch w filter |
4,833 |
1,025 |
$98K |
| A5063 |
Drain ostomy pouch w/flange |
2,425 |
1,943 |
$90K |
| A4349 |
Disposable male external cat |
2,379 |
1,816 |
$90K |
| A4407 |
Ext wear ost skn barr <=4sq" |
1,276 |
1,099 |
$89K |
| A4357 |
Bedside drainage bag |
6,120 |
4,907 |
$74K |
| A5061 |
Pouch drainable w barrier at |
1,198 |
915 |
$64K |
| A4452 |
Waterproof tape |
2,836 |
2,531 |
$54K |
| A6446 |
Conform band s w>=3" <5"/yd |
1,455 |
1,253 |
$54K |
| A4250 |
Urine reagent strips/tablets |
2,815 |
2,498 |
$50K |
| A6250 |
Skin seal protect moisturizr |
562 |
436 |
$49K |
| A4322 |
Irrigation syringe |
2,716 |
2,384 |
$46K |
| B4149 |
Ef blenderized foods |
313 |
124 |
$45K |
| A4310 |
Insert tray w/o bag/cath |
1,952 |
1,571 |
$39K |
| A4394 |
Ostomy pouch liq deodorant |
2,160 |
1,878 |
$38K |
| A5120 |
Skin barrier, wipe or swab |
5,423 |
4,585 |
$36K |
| A4338 |
Indwelling catheter latex |
1,991 |
1,650 |
$33K |
| A6212 |
Foam drg <=16 sq in w/border |
303 |
252 |
$32K |
| A4456 |
Adhesive remover, wipes |
4,028 |
3,287 |
$31K |
| A5073 |
Urinary pouch on barr w/flng |
937 |
845 |
$30K |
| E0248 |
Hdtrans bench w/wo comm open |
157 |
144 |
$29K |
| E0241 |
Bath tub wall rail |
927 |
712 |
$27K |
| A4402 |
Lubricant per ounce |
2,479 |
2,106 |
$27K |
| A4358 |
Urinary leg or abdomen bag |
3,088 |
2,492 |
$26K |
| A4353 |
Intermittent urinary cath |
88 |
65 |
$25K |
| E0143 |
Walker folding wheeled w/o s |
289 |
238 |
$22K |
| A4450 |
Non-waterproof tape |
2,807 |
2,415 |
$20K |
| A4406 |
Pectin based ostomy paste |
3,576 |
3,070 |
$20K |
| A6196 |
Alginate dressing <=16 sq in |
179 |
156 |
$19K |
| A9278 |
External receiver, cgm sys |
42 |
42 |
$15K |
| A4409 |
Ost skn barr convex <=4 sq i |
788 |
575 |
$15K |
| K0554 |
Ther cgm receiver/monitor |
71 |
56 |
$14K |
| A6197 |
Alginate drsg >16 <=48 sq in |
116 |
102 |
$12K |
| E0163 |
Commode chair with fixed arm |
196 |
173 |
$9K |
| B4034 |
Enter feed supkit syr by day |
1,244 |
316 |
$9K |
| B9002 |
Enter nutr inf pump any type |
344 |
181 |
$8K |
| B4154 |
Ef spec metabolic noninherit |
30 |
24 |
$8K |
| B4155 |
Ef incomplete/modular |
246 |
184 |
$6K |
| A4217 |
Sterile water/saline, 500 ml |
1,228 |
1,082 |
$6K |
| A4371 |
Skin barrier powder per oz |
1,376 |
1,125 |
$5K |
| A6403 |
Sterile gauze>16 <= 48 sq in |
82 |
76 |
$4K |
| A4627 |
Spacer bag/reservoir |
129 |
122 |
$4K |
| E0244 |
Toilet seat raised |
206 |
169 |
$4K |
| A4331 |
Extension drainage tubing |
669 |
529 |
$3K |
| E0156 |
Walker seat attachment |
222 |
167 |
$2K |
| A6266 |
Impreg gauze no h20/sal/yard |
55 |
49 |
$2K |
| A5057 |
1 pc ost pou w built-in conv |
148 |
12 |
$2K |
| T4533 |
Youth size brief/diaper |
14 |
14 |
$1K |
| A4369 |
Skin barrier liquid per oz |
315 |
271 |
$1K |
| A6219 |
Gauze <= 16 sq in w/border |
48 |
40 |
$652.14 |
| A4628 |
Oropharyngeal suction cath |
16 |
12 |
$308.84 |
| A4367 |
Ostomy belt |
25 |
24 |
$118.19 |