| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
408,516 |
403,635 |
$24.30M |
| A4554 |
Disposable underpads |
1,277,478 |
1,262,375 |
$19.22M |
| T4526 |
Adult size pull-on med |
370,202 |
365,901 |
$18.32M |
| T4528 |
Adult size pull-on xl |
248,908 |
245,878 |
$17.35M |
| T4535 |
Disposable liner/shield/pad |
569,080 |
546,871 |
$10.03M |
| T4544 |
Adlt disp und/pull on abv xl |
100,535 |
99,420 |
$8.41M |
| A4335 |
Incontinence supply |
1,907,676 |
1,886,204 |
$6.74M |
| T4534 |
Youth size pull-on |
115,843 |
113,464 |
$3.88M |
| T4523 |
Adult size brief/diaper lg |
96,394 |
95,147 |
$3.85M |
| T4522 |
Adult size brief/diaper med |
92,233 |
91,031 |
$3.31M |
| A6250 |
Skin seal protect moisturizr |
948,307 |
938,704 |
$3.28M |
| T4524 |
Adult size brief/diaper xl |
54,151 |
53,471 |
$2.92M |
| T4543 |
Adult disp brief/diap abv xl |
35,262 |
34,762 |
$2.47M |
| T4525 |
Adult size pull-on sm |
57,113 |
56,419 |
$2.25M |
| B4150 |
Ef complet w/intact nutrient |
14,441 |
12,557 |
$1.86M |
| A4351 |
Straight tip urine catheter |
9,699 |
9,221 |
$1.44M |
| A4353 |
Intermittent urinary cath |
3,101 |
2,926 |
$1.42M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
6,087 |
5,875 |
$1.28M |
| T4532 |
Ped size pull-on lg |
25,443 |
24,825 |
$1.15M |
| B4154 |
Ef spec metabolic noninherit |
3,914 |
3,338 |
$1.09M |
| E0240 |
Bath/shower chair |
11,228 |
10,501 |
$962K |
| T4530 |
Ped size brief/diaper lg |
31,602 |
30,882 |
$962K |
| B4152 |
Ef calorie dense>/=1.5kcal |
4,233 |
3,850 |
$956K |
| A4670 |
Automatic bp monitor, dial |
9,327 |
9,272 |
$466K |
| T4521 |
Adult size brief/diaper sm |
13,107 |
12,894 |
$419K |
| E1399 |
Durable medical equipment mi |
10,316 |
9,394 |
$396K |
| T2029 |
Special med equip, noswaiver |
4,836 |
4,336 |
$395K |
| A4352 |
Coude tip urinary catheter |
839 |
818 |
$368K |
| B4035 |
Enteral feed supp pump per d |
2,937 |
2,268 |
$363K |
| B4100 |
Food thickener oral |
3,627 |
3,514 |
$336K |
| A4253 |
Blood glucose/reagent strips |
17,343 |
16,163 |
$327K |
| B4161 |
Ef ped hydrolyzed/amino acid |
442 |
421 |
$296K |
| B9998 |
Enteral supp not otherwise c |
4,750 |
4,420 |
$295K |
| B4034 |
Enter feed supkit syr by day |
4,340 |
3,828 |
$276K |
| E0260 |
Hosp bed semi-electr w/ matt |
1,524 |
1,490 |
$268K |
| E0143 |
Walker folding wheeled w/o s |
5,207 |
5,117 |
$261K |
| K0003 |
Lightweight wheelchair |
1,176 |
1,141 |
$186K |
| E0247 |
Trans bench w/wo comm open |
2,657 |
2,446 |
$186K |
| A6212 |
Foam drg <=16 sq in w/border |
848 |
807 |
$150K |
| K0001 |
Standard wheelchair |
1,476 |
1,437 |
$141K |
| A5061 |
Pouch drainable w barrier at |
1,593 |
1,542 |
$130K |
| A4409 |
Ost skn barr convex <=4 sq i |
1,368 |
1,289 |
$130K |
| E0570 |
Nebulizer with compression |
1,952 |
1,886 |
$106K |
| E0248 |
Hdtrans bench w/wo comm open |
629 |
600 |
$94K |
| B4155 |
Ef incomplete/modular |
529 |
491 |
$84K |
| A4362 |
Solid skin barrier |
1,187 |
1,155 |
$79K |
| A4385 |
Ost skn barrier sld ext wear |
994 |
968 |
$73K |
| E0163 |
Commode chair with fixed arm |
1,238 |
1,220 |
$71K |
| A4349 |
Disposable male external cat |
2,029 |
1,955 |
$68K |
| E0149 |
Heavy duty wheeled walker |
832 |
821 |
$67K |
| A4927 |
Non-sterile gloves |
65,934 |
64,563 |
$67K |
| B4036 |
Enteral feed sup kit grav by |
907 |
774 |
$64K |
| A4259 |
Lancets per box |
13,153 |
12,594 |
$64K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
944 |
866 |
$60K |
| A4357 |
Bedside drainage bag |
7,287 |
6,829 |
$57K |
| T2028 |
Special supply, nos waiver |
296 |
291 |
$57K |
| E0603 |
Electric breast pump |
619 |
590 |
$57K |
| E0246 |
Transfer tub rail attachment |
1,335 |
1,292 |
$54K |
| B4153 |
Ef hydrolyzed/amino acids |
65 |
62 |
$52K |
| A4394 |
Ostomy pouch liq deodorant |
1,937 |
1,892 |
$50K |
| E0243 |
Toilet rail |
907 |
872 |
$50K |
| E0244 |
Toilet seat raised |
1,824 |
1,805 |
$50K |
| A4377 |
Drainable plstic pch w/o fp |
881 |
864 |
$49K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
634 |
612 |
$49K |
| T4542 |
Small disposable underpad |
1,992 |
1,788 |
$46K |
| T4529 |
Ped size brief/diaper sm/med |
2,013 |
1,967 |
$43K |
| T4531 |
Ped size pull-on sm/med |
963 |
950 |
$41K |
| A4338 |
Indwelling catheter latex |
3,726 |
3,510 |
$36K |
| T4533 |
Youth size brief/diaper |
1,830 |
1,796 |
$34K |
| A4452 |
Waterproof tape |
1,976 |
1,823 |
$33K |
| E0445 |
Oximeter non-invasive |
741 |
729 |
$33K |
| A4358 |
Urinary leg or abdomen bag |
4,493 |
4,174 |
$32K |
| E0105 |
Cane adjust/fixed quad/3 pro |
1,290 |
1,267 |
$32K |
| A6402 |
Sterile gauze <= 16 sq in |
5,842 |
5,448 |
$32K |
| B4088 |
Gastro/jejuno tube, low-pro |
1,283 |
1,205 |
$31K |
| A4217 |
Sterile water/saline, 500 ml |
3,964 |
3,815 |
$30K |
| A4388 |
Drainable pch w ex wear barr |
267 |
265 |
$26K |
| A6197 |
Alginate drsg >16 <=48 sq in |
188 |
172 |
$26K |
| A4406 |
Pectin based ostomy paste |
2,513 |
2,426 |
$26K |
| A4402 |
Lubricant per ounce |
7,320 |
7,180 |
$26K |
| A4456 |
Adhesive remover, wipes |
3,089 |
3,002 |
$24K |
| A4424 |
Ost pch drain w bar & filter |
259 |
251 |
$21K |
| A5120 |
Skin barrier, wipe or swab |
4,020 |
3,662 |
$20K |
| A6260 |
Wound cleanser any type/size |
809 |
776 |
$19K |
| E0277 |
Powered pres-redu air mattrs |
89 |
87 |
$19K |
| E0630 |
Patient lift hydraulic |
149 |
148 |
$18K |
| K0007 |
Extra heavy duty wheelchair |
83 |
81 |
$16K |
| A6216 |
Non-sterile gauze<=16 sq in |
2,438 |
2,292 |
$15K |
| K0006 |
Heavy duty wheelchair |
95 |
93 |
$14K |
| A4450 |
Non-waterproof tape |
4,598 |
4,445 |
$14K |
| A6266 |
Impreg gauze no h20/sal/yard |
166 |
150 |
$13K |
| A4344 |
Cath indw foley 2 way silicn |
786 |
754 |
$12K |
| E0100 |
Cane adjust/fixed with tip |
1,112 |
1,095 |
$12K |
| A5063 |
Drain ostomy pouch w/flange |
282 |
275 |
$11K |
| E0245 |
Tub stool or bench |
359 |
348 |
$11K |
| A4245 |
Alcohol wipes per box |
9,217 |
9,029 |
$11K |
| E0990 |
Wheelchair elevating leg res |
87 |
84 |
$11K |
| E0303 |
Hosp bed hvy dty xtra wide |
37 |
37 |
$8K |
| A4322 |
Irrigation syringe |
2,664 |
2,516 |
$8K |
| A4425 |
Ost pch drain for barrier fl |
207 |
200 |
$7K |
| A6446 |
Conform band s w>=3" <5"/yd |
147 |
145 |
$7K |
| A5112 |
Urinary leg bag |
194 |
182 |
$6K |
| A4310 |
Insert tray w/o bag/cath |
3,499 |
3,324 |
$5K |
| A7003 |
Nebulizer administration set |
2,135 |
2,030 |
$4K |
| A4371 |
Skin barrier powder per oz |
1,387 |
1,350 |
$4K |
| A4320 |
Irrigation tray |
447 |
438 |
$4K |
| T4537 |
Reusable underpad bed size |
1,099 |
1,059 |
$4K |
| A4331 |
Extension drainage tubing |
1,655 |
1,566 |
$3K |
| A4426 |
Ost pch drain 2 piece system |
72 |
65 |
$2K |
| A4369 |
Skin barrier liquid per oz |
432 |
407 |
$2K |
| A4239 |
Non-adju cgm supply allow |
12 |
12 |
$2K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
12 |
12 |
$2K |
| A6449 |
Lt compres band >=3" <5"/yd |
26 |
25 |
$2K |
| E0185 |
Gel pressure mattress pad |
12 |
12 |
$2K |
| A7015 |
Aerosol mask used w nebulize |
1,900 |
1,792 |
$2K |
| E2611 |
Gen use back cush wdth <22in |
17 |
14 |
$1K |
| E1390 |
Oxygen concentrator |
54 |
54 |
$1K |
| A4258 |
Lancet device each |
623 |
596 |
$1K |
| A6443 |
Conform band n/s w>=3"<5"/yd |
85 |
80 |
$1K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
14 |
14 |
$1K |
| A4520 |
Incontinence garment anytype |
2,007 |
1,721 |
$1K |
| E0635 |
Patient lift electric |
12 |
12 |
$1K |
| E2601 |
Gen w/c cushion wdth < 22 in |
35 |
29 |
$1K |
| A5200 |
Percutaneous catheter anchor |
38 |
36 |
$830.73 |
| A4455 |
Adhesive remover per ounce |
191 |
190 |
$716.07 |
| B9002 |
Enter nutr inf pump any type |
12 |
12 |
$655.88 |
| A9286 |
Any hygienic item, device |
1,777 |
1,671 |
$606.01 |
| A4216 |
Sterile water/saline, 10 ml |
42 |
37 |
$565.44 |
| A6454 |
Self-adher band w>=3" <5"/yd |
13 |
12 |
$348.25 |
| A4256 |
Calibrator solution/chips |
50 |
50 |
$221.00 |
| A4246 |
Betadine/phisohex solution |
50 |
50 |
$175.33 |
| E0325 |
Urinal male jug-type |
12 |
12 |
$94.02 |
| E0156 |
Walker seat attachment |
85 |
81 |
$13.21 |
| S9999 |
Sales tax |
30,835 |
30,206 |
$0.00 |
| E0621 |
Patient lift sling or seat |
12 |
12 |
$0.00 |
| A9270 |
Non-covered item or service |
16 |
16 |
$0.00 |
| E0607 |
Blood glucose monitor home |
49 |
49 |
$0.00 |
| E0241 |
Bath tub wall rail |
15 |
14 |
$0.00 |