| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4353 |
Intermittent urinary cath |
30,886 |
22,681 |
$18.51M |
| A4351 |
Straight tip urine catheter |
41,119 |
29,893 |
$3.50M |
| A4554 |
Disposable underpads |
85,849 |
60,880 |
$2.70M |
| T4526 |
Adult size pull-on med |
30,119 |
22,611 |
$2.35M |
| A4352 |
Coude tip urinary catheter |
7,627 |
5,728 |
$2.27M |
| T4527 |
Adult size pull-on lg |
24,981 |
19,150 |
$2.21M |
| T4534 |
Youth size pull-on |
16,888 |
12,321 |
$1.50M |
| T4522 |
Adult size brief/diaper med |
16,057 |
11,351 |
$1.39M |
| T4528 |
Adult size pull-on xl |
15,719 |
11,928 |
$1.37M |
| T4532 |
Ped size pull-on lg |
13,403 |
8,229 |
$1.13M |
| T4523 |
Adult size brief/diaper lg |
10,056 |
7,496 |
$931K |
| A4927 |
Non-sterile gloves |
64,616 |
49,540 |
$854K |
| T4521 |
Adult size brief/diaper sm |
9,420 |
6,218 |
$764K |
| T4544 |
Adlt disp und/pull on abv xl |
5,088 |
3,911 |
$671K |
| T4537 |
Reusable underpad bed size |
16,534 |
16,107 |
$637K |
| T4530 |
Ped size brief/diaper lg |
10,185 |
6,604 |
$599K |
| T4535 |
Disposable liner/shield/pad |
18,336 |
13,352 |
$575K |
| B4149 |
Ef blenderized foods |
2,283 |
1,194 |
$484K |
| B4035 |
Enteral feed supp pump per d |
4,972 |
1,995 |
$456K |
| T4533 |
Youth size brief/diaper |
5,873 |
3,751 |
$424K |
| T4541 |
Large disposable underpad |
18,576 |
17,657 |
$423K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
6,137 |
3,836 |
$413K |
| T4525 |
Adult size pull-on sm |
4,504 |
3,495 |
$388K |
| B4161 |
Ef ped hydrolyzed/amino acid |
1,398 |
820 |
$344K |
| T4543 |
Adult disp brief/diap abv xl |
1,915 |
1,600 |
$320K |
| T4524 |
Adult size brief/diaper xl |
3,506 |
2,696 |
$318K |
| B4150 |
Ef complet w/intact nutrient |
4,670 |
3,165 |
$306K |
| A4344 |
Cath indw foley 2 way silicn |
3,029 |
2,144 |
$253K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,943 |
1,258 |
$166K |
| A4349 |
Disposable male external cat |
5,316 |
3,703 |
$126K |
| B4154 |
Ef spec metabolic noninherit |
1,442 |
988 |
$117K |
| B4034 |
Enter feed supkit syr by day |
1,732 |
732 |
$97K |
| A4357 |
Bedside drainage bag |
11,572 |
8,302 |
$94K |
| A4385 |
Ost skn barrier sld ext wear |
1,741 |
1,554 |
$84K |
| A4310 |
Insert tray w/o bag/cath |
3,246 |
2,350 |
$81K |
| A4213 |
20+ cc syringe only |
4,663 |
3,432 |
$72K |
| B4088 |
Gastro/jejuno tube, low-pro |
1,260 |
766 |
$68K |
| A4409 |
Ost skn barr convex <=4 sq i |
1,135 |
999 |
$62K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
1,304 |
1,111 |
$55K |
| A4217 |
Sterile water/saline, 500 ml |
2,362 |
1,775 |
$54K |
| A4335 |
Incontinence supply |
4,445 |
3,732 |
$53K |
| A4400 |
Ostomy irrigation set |
1,442 |
965 |
$50K |
| W0137 |
|
975 |
928 |
$45K |
| A4332 |
Lube sterile packet |
7,478 |
6,216 |
$44K |
| A4358 |
Urinary leg or abdomen bag |
8,340 |
6,111 |
$41K |
| A4425 |
Ost pch drain for barrier fl |
1,151 |
1,025 |
$40K |
| A4407 |
Ext wear ost skn barr <=4sq" |
494 |
445 |
$37K |
| B4100 |
Food thickener oral |
631 |
359 |
$36K |
| A4362 |
Solid skin barrier |
1,255 |
1,083 |
$34K |
| A4553 |
Nondisp underpads, all sizes |
1,690 |
1,625 |
$34K |
| T5999 |
Supply, nos |
3,802 |
3,732 |
$33K |
| B4103 |
Ef ped fluid and electrolyte |
393 |
234 |
$30K |
| A4402 |
Lubricant per ounce |
7,824 |
5,996 |
$25K |
| X1939 |
|
400 |
399 |
$22K |
| B4155 |
Ef incomplete/modular |
271 |
192 |
$18K |
| A5063 |
Drain ostomy pouch w/flange |
720 |
620 |
$17K |
| A5120 |
Skin barrier, wipe or swab |
4,332 |
3,428 |
$17K |
| A5061 |
Pouch drainable w barrier at |
465 |
348 |
$13K |
| A4338 |
Indwelling catheter latex |
1,954 |
1,418 |
$13K |
| A4456 |
Adhesive remover, wipes |
3,036 |
2,681 |
$12K |
| A4394 |
Ostomy pouch liq deodorant |
1,065 |
900 |
$11K |
| A4419 |
Ost pch for bar w flange/flt |
266 |
234 |
$11K |
| A4520 |
Incontinence garment anytype |
2,635 |
2,446 |
$10K |
| A4314 |
Cath w/drainage 2-way latex |
1,094 |
721 |
$8K |
| T4531 |
Ped size pull-on sm/med |
102 |
69 |
$8K |
| A4406 |
Pectin based ostomy paste |
807 |
685 |
$7K |
| A4399 |
Ostomy irrig cone/cath w brs |
689 |
581 |
$6K |
| A4322 |
Irrigation syringe |
1,182 |
896 |
$6K |
| A4371 |
Skin barrier powder per oz |
1,461 |
1,244 |
$5K |
| A6250 |
Skin seal protect moisturizr |
319 |
271 |
$4K |
| A4315 |
Cath w/drainage 2-way silcne |
158 |
121 |
$2K |
| A4432 |
Os pch urine w bar/fange/tap |
61 |
58 |
$2K |
| B9998 |
Enteral supp not otherwise c |
159 |
132 |
$2K |
| A4333 |
Urinary cath anchor device |
1,022 |
608 |
$1K |
| A4367 |
Ostomy belt |
451 |
418 |
$1K |
| A4331 |
Extension drainage tubing |
332 |
213 |
$800.08 |
| A4334 |
Urinary cath leg strap |
245 |
186 |
$656.96 |
| A6402 |
Sterile gauze <= 16 sq in |
61 |
52 |
$437.00 |
| A4452 |
Waterproof tape |
43 |
37 |
$295.45 |
| A4450 |
Non-waterproof tape |
110 |
93 |
$198.17 |
| A4455 |
Adhesive remover per ounce |
37 |
36 |
$70.59 |
| A9270 |
Non-covered item or service |
97 |
89 |
$0.00 |