| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
241 |
222 |
$12K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
315 |
243 |
$8K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
114 |
87 |
$5K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
88 |
72 |
$4K |
| T4541 |
Incontinence product, disposable underpad, large, each |
133 |
98 |
$3K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
831 |
685 |
$2K |
| A4927 |
Gloves, non-sterile, per 100 |
414 |
355 |
$2K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
307 |
270 |
$2K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
38 |
36 |
$1K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
42 |
29 |
$1K |
| A5120 |
Skin barrier, wipes or swabs, each |
521 |
428 |
$1K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
150 |
138 |
$1K |
| A4335 |
Incontinence supply; miscellaneous |
313 |
231 |
$830.38 |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
17 |
12 |
$750.46 |
| A6252 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
13 |
13 |
$733.60 |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
181 |
130 |
$631.97 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
185 |
160 |
$496.08 |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
55 |
38 |
$441.78 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
77 |
75 |
$416.59 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
151 |
109 |
$395.17 |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
26 |
25 |
$153.54 |
| A4456 |
Adhesive remover, wipes, any type, each |
41 |
39 |
$135.20 |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
54 |
39 |
$58.04 |