| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A5500 |
Diab shoe for density insert |
11,231 |
8,302 |
$388K |
| A5512 |
Multi den insert direct form |
11,309 |
8,427 |
$239K |
| A5503 |
Diabetic shoe w/roller/rockr |
9,390 |
7,313 |
$160K |
| T4527 |
Adult size pull-on lg |
1,482 |
1,463 |
$156K |
| B4154 |
Ef spec metabolic noninherit |
1,486 |
1,350 |
$140K |
| T4528 |
Adult size pull-on xl |
981 |
972 |
$136K |
| B4035 |
Enteral feed supp pump per d |
4,470 |
3,971 |
$114K |
| B4152 |
Ef calorie dense>/=1.5kcal |
2,773 |
2,515 |
$101K |
| T4526 |
Adult size pull-on med |
892 |
884 |
$90K |
| T4541 |
Large disposable underpad |
1,341 |
1,325 |
$83K |
| T4535 |
Disposable liner/shield/pad |
1,712 |
1,690 |
$76K |
| B9002 |
Enter nutr inf pump any type |
2,290 |
2,033 |
$25K |
| B4150 |
Ef complet w/intact nutrient |
703 |
625 |
$14K |
| A5061 |
Pouch drainable w barrier at |
492 |
485 |
$7K |
| A4409 |
Ost skn barr convex <=4 sq i |
354 |
347 |
$5K |
| A5063 |
Drain ostomy pouch w/flange |
800 |
777 |
$4K |
| A4357 |
Bedside drainage bag |
3,656 |
3,509 |
$3K |
| B4034 |
Enter feed supkit syr by day |
282 |
270 |
$1K |
| A4388 |
Drainable pch w ex wear barr |
102 |
102 |
$1K |
| A4338 |
Indwelling catheter latex |
2,196 |
2,164 |
$1K |
| A4314 |
Cath w/drainage 2-way latex |
1,344 |
1,225 |
$1K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
150 |
137 |
$1K |
| E0776 |
Iv pole |
1,441 |
1,395 |
$998.19 |
| A4310 |
Insert tray w/o bag/cath |
2,196 |
2,157 |
$861.96 |
| A4407 |
Ext wear ost skn barr <=4sq" |
15 |
15 |
$795.86 |
| A4425 |
Ost pch drain for barrier fl |
104 |
102 |
$780.41 |
| A4927 |
Non-sterile gloves |
36 |
36 |
$454.13 |
| A4385 |
Ost skn barrier sld ext wear |
107 |
98 |
$386.37 |
| A4394 |
Ostomy pouch liq deodorant |
126 |
112 |
$185.29 |
| A4333 |
Urinary cath anchor device |
266 |
237 |
$168.67 |
| A5120 |
Skin barrier, wipe or swab |
263 |
238 |
$113.14 |
| A4334 |
Urinary cath leg strap |
248 |
202 |
$53.52 |
| A4358 |
Urinary leg or abdomen bag |
118 |
113 |
$49.24 |
| A4623 |
Tracheostomy inner cannula |
99 |
99 |
$35.70 |
| A4456 |
Adhesive remover, wipes |
92 |
84 |
$32.91 |
| A4371 |
Skin barrier powder per oz |
101 |
93 |
$14.64 |
| A4406 |
Pectin based ostomy paste |
124 |
111 |
$12.38 |
| A4320 |
Irrigation tray |
49 |
42 |
$6.59 |
| A4629 |
Tracheostomy care kit |
77 |
76 |
$0.00 |