| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
123,618 |
104,479 |
$6.33M |
| T4526 |
Adult size pull-on med |
44,896 |
37,817 |
$5.15M |
| T4527 |
Adult size pull-on lg |
37,543 |
31,312 |
$4.81M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
19,653 |
12,254 |
$4.74M |
| T4535 |
Disposable liner/shield/pad |
64,920 |
51,961 |
$3.01M |
| B4161 |
Ef ped hydrolyzed/amino acid |
4,241 |
3,325 |
$3.01M |
| T4534 |
Youth size pull-on |
16,731 |
15,988 |
$2.90M |
| A4927 |
Non-sterile gloves |
176,952 |
116,797 |
$2.54M |
| T4528 |
Adult size pull-on xl |
20,030 |
16,801 |
$2.47M |
| B4150 |
Ef complet w/intact nutrient |
40,251 |
17,751 |
$2.01M |
| T4522 |
Adult size brief/diaper med |
18,113 |
15,929 |
$2.00M |
| B4035 |
Enteral feed supp pump per d |
7,835 |
7,098 |
$1.92M |
| T4525 |
Adult size pull-on sm |
15,366 |
14,095 |
$1.60M |
| T4523 |
Adult size brief/diaper lg |
12,632 |
10,888 |
$1.53M |
| A4409 |
Ost skn barr convex <=4 sq i |
8,997 |
8,109 |
$1.19M |
| T4544 |
Adlt disp und/pull on abv xl |
6,594 |
5,462 |
$1.18M |
| A4351 |
Straight tip urine catheter |
10,111 |
8,663 |
$1.14M |
| B4154 |
Ef spec metabolic noninherit |
10,049 |
4,432 |
$1.09M |
| A6197 |
Alginate drsg >16 <=48 sq in |
3,185 |
2,036 |
$1.02M |
| B4152 |
Ef calorie dense>/=1.5kcal |
12,103 |
5,950 |
$965K |
| T4530 |
Ped size brief/diaper lg |
9,994 |
9,488 |
$882K |
| T4524 |
Adult size brief/diaper xl |
7,453 |
6,281 |
$861K |
| B4087 |
Gastro/jejuno tube, std |
10,324 |
6,945 |
$817K |
| A6212 |
Foam drg <=16 sq in w/border |
6,419 |
3,923 |
$799K |
| A4425 |
Ost pch drain for barrier fl |
9,635 |
8,485 |
$786K |
| B4149 |
Ef blenderized foods |
1,564 |
1,326 |
$596K |
| A6250 |
Skin seal protect moisturizr |
109,312 |
72,311 |
$594K |
| B9998 |
Enteral supp not otherwise c |
13,295 |
8,582 |
$580K |
| A4385 |
Ost skn barrier sld ext wear |
7,865 |
7,373 |
$571K |
| A4407 |
Ext wear ost skn barr <=4sq" |
2,594 |
2,435 |
$488K |
| T4521 |
Adult size brief/diaper sm |
3,975 |
3,658 |
$459K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
1,720 |
1,139 |
$403K |
| T4532 |
Ped size pull-on lg |
3,019 |
2,824 |
$305K |
| B4153 |
Ef hydrolyzed/amino acids |
405 |
340 |
$294K |
| A6021 |
Collagen dressing <=16 sq in |
1,127 |
772 |
$281K |
| A4553 |
Nondisp underpads, all sizes |
14,849 |
10,883 |
$254K |
| B4155 |
Ef incomplete/modular |
1,513 |
1,155 |
$254K |
| B4158 |
Ef ped complete intact nut |
1,115 |
984 |
$226K |
| T4543 |
Adult disp brief/diap abv xl |
971 |
861 |
$200K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
3,361 |
2,469 |
$155K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
1,712 |
1,475 |
$153K |
| A4362 |
Solid skin barrier |
3,026 |
2,828 |
$126K |
| A4456 |
Adhesive remover, wipes |
9,009 |
8,236 |
$126K |
| A9286 |
Any hygienic item, device |
9,779 |
9,355 |
$125K |
| B9002 |
Enter nutr inf pump any type |
160 |
150 |
$124K |
| A6446 |
Conform band s w>=3" <5"/yd |
4,670 |
3,314 |
$122K |
| A4394 |
Ostomy pouch liq deodorant |
6,362 |
5,816 |
$120K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
763 |
504 |
$120K |
| B4036 |
Enteral feed sup kit grav by |
1,767 |
1,396 |
$117K |
| B4034 |
Enter feed supkit syr by day |
946 |
806 |
$113K |
| A4357 |
Bedside drainage bag |
8,976 |
8,111 |
$112K |
| A5063 |
Drain ostomy pouch w/flange |
2,475 |
2,113 |
$112K |
| A6449 |
Lt compres band >=3" <5"/yd |
1,496 |
1,072 |
$94K |
| A6454 |
Self-adher band w>=3" <5"/yd |
1,702 |
1,199 |
$89K |
| A4452 |
Waterproof tape |
5,756 |
4,715 |
$88K |
| B4100 |
Food thickener oral |
2,558 |
1,597 |
$83K |
| A4419 |
Ost pch for bar w flange/flt |
1,312 |
1,241 |
$81K |
| A4349 |
Disposable male external cat |
2,136 |
1,844 |
$80K |
| A6216 |
Non-sterile gauze<=16 sq in |
9,150 |
6,570 |
$78K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
1,250 |
890 |
$75K |
| A4338 |
Indwelling catheter latex |
4,595 |
4,118 |
$75K |
| A4406 |
Pectin based ostomy paste |
4,253 |
3,862 |
$68K |
| A4239 |
Non-adju cgm supply allow |
409 |
384 |
$65K |
| A5120 |
Skin barrier, wipe or swab |
9,419 |
8,838 |
$64K |
| A4310 |
Insert tray w/o bag/cath |
4,176 |
3,750 |
$57K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
596 |
395 |
$57K |
| A4322 |
Irrigation syringe |
3,314 |
2,880 |
$55K |
| A6260 |
Wound cleanser any type/size |
6,560 |
4,782 |
$48K |
| A4432 |
Os pch urine w bar/fange/tap |
724 |
639 |
$43K |
| A4344 |
Cath indw foley 2 way silicn |
1,606 |
1,497 |
$37K |
| A6402 |
Sterile gauze <= 16 sq in |
3,411 |
2,773 |
$32K |
| A4358 |
Urinary leg or abdomen bag |
4,608 |
4,204 |
$29K |
| A4402 |
Lubricant per ounce |
5,926 |
5,502 |
$25K |
| T4533 |
Youth size brief/diaper |
221 |
214 |
$25K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
251 |
220 |
$19K |
| A4333 |
Urinary cath anchor device |
1,365 |
1,214 |
$19K |
| A4371 |
Skin barrier powder per oz |
5,178 |
4,827 |
$17K |
| A5057 |
1 pc ost pou w built-in conv |
84 |
75 |
$15K |
| A4373 |
Skin barrier with flange |
115 |
107 |
$14K |
| A4367 |
Ostomy belt |
2,079 |
1,956 |
$14K |
| A6199 |
Alginate drsg wound filler |
105 |
75 |
$12K |
| K0553 |
Ther cgm supply allowance |
66 |
64 |
$11K |
| A9901 |
Delivery/set up/dispensing |
1,117 |
789 |
$10K |
| A6248 |
Hydrogel drsg gel filler |
455 |
315 |
$10K |
| A6452 |
High compres band w>=3"<5"yd |
43 |
26 |
$10K |
| B4081 |
Enteral ng tubing w/ stylet |
128 |
100 |
$9K |
| A4314 |
Cath w/drainage 2-way latex |
766 |
752 |
$7K |
| A4369 |
Skin barrier liquid per oz |
1,399 |
1,304 |
$6K |
| A6257 |
Transparent film <= 16 sq in |
287 |
265 |
$5K |
| A4455 |
Adhesive remover per ounce |
2,337 |
2,190 |
$5K |
| A4450 |
Non-waterproof tape |
1,863 |
1,218 |
$5K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
43 |
38 |
$4K |
| E2103 |
Non-adju cgm receiver/mon |
18 |
18 |
$4K |
| A4332 |
Lube sterile packet |
232 |
204 |
$4K |
| A6196 |
Alginate dressing <=16 sq in |
63 |
38 |
$4K |
| A4364 |
Adhesive, liquid or equal |
457 |
393 |
$3K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
65 |
39 |
$2K |
| E0776 |
Iv pole |
14 |
13 |
$2K |
| B4102 |
Ef adult fluids and electro |
13 |
12 |
$646.13 |
| T5999 |
Supply, nos |
812 |
692 |
$577.78 |
| A4216 |
Sterile water/saline, 10 ml |
119 |
102 |
$490.17 |
| A4247 |
Betadine/iodine swabs/wipes |
50 |
39 |
$343.87 |
| A4320 |
Irrigation tray |
29 |
29 |
$156.08 |