| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
14,727 |
12,833 |
$2.37M |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
4,707 |
4,212 |
$1.44M |
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
11,078 |
6,942 |
$1.43M |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
10,493 |
9,034 |
$1.39M |
| 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 |
3,261 |
2,861 |
$1.07M |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
5,719 |
4,909 |
$822K |
| 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 |
10,344 |
9,134 |
$788K |
| A6213 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
2,308 |
1,973 |
$618K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
3,370 |
3,060 |
$564K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
2,418 |
2,113 |
$522K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
5,186 |
4,338 |
$505K |
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
6,336 |
4,109 |
$496K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
3,576 |
3,177 |
$481K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
3,003 |
2,611 |
$406K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,844 |
2,424 |
$401K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
22,503 |
19,696 |
$381K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
3,376 |
3,046 |
$365K |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
3,652 |
2,574 |
$352K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
3,020 |
2,552 |
$317K |
| B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
427 |
322 |
$289K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,400 |
2,159 |
$275K |
| A4624 |
Tracheal suction catheter, any type other than closed system, each |
2,285 |
2,044 |
$275K |
| A6210 |
Foam 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 |
1,057 |
946 |
$273K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
10,070 |
9,357 |
$267K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
4,508 |
3,266 |
$262K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
2,957 |
2,487 |
$261K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
2,799 |
2,352 |
$246K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,862 |
1,497 |
$245K |
| A4452 |
Tape, waterproof, per 18 square inches |
10,303 |
9,439 |
$223K |
| A4623 |
Tracheostomy, inner cannula |
2,647 |
2,370 |
$207K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,767 |
2,518 |
$206K |
| A6260 |
Wound cleansers, any type, any size |
13,326 |
12,319 |
$172K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
979 |
845 |
$172K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
1,747 |
1,586 |
$163K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,299 |
1,154 |
$163K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
2,796 |
2,659 |
$157K |
| B9998 |
Noc for enteral supplies |
3,917 |
3,013 |
$151K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
2,832 |
2,675 |
$140K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
3,595 |
3,050 |
$139K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
3,373 |
3,238 |
$103K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
2,161 |
2,046 |
$94K |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
1,504 |
1,214 |
$90K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
2,803 |
2,649 |
$88K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
406 |
357 |
$78K |
| A4554 |
Disposable underpads, all sizes |
1,725 |
1,512 |
$74K |
| A6199 |
Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches |
810 |
737 |
$74K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
1,160 |
1,122 |
$71K |
| A4927 |
Gloves, non-sterile, per 100 |
11,011 |
10,384 |
$66K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
9,498 |
8,721 |
$64K |
| A7520 |
Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each |
2,311 |
2,070 |
$63K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
2,570 |
2,423 |
$62K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
1,577 |
1,509 |
$61K |
| A5120 |
Skin barrier, wipes or swabs, each |
11,901 |
11,188 |
$58K |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
949 |
902 |
$53K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
5,555 |
5,111 |
$50K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
3,248 |
2,633 |
$47K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
4,511 |
4,286 |
$45K |
| A4456 |
Adhesive remover, wipes, any type, each |
7,582 |
7,243 |
$44K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,704 |
4,285 |
$43K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,315 |
1,185 |
$41K |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
1,486 |
880 |
$40K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
1,635 |
1,523 |
$40K |
| A7000 |
Canister, disposable, used with suction pump, each |
3,111 |
2,807 |
$36K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
392 |
201 |
$34K |
| A4332 |
Lubricant, individual sterile packet, each |
2,386 |
2,038 |
$30K |
| A7526 |
Tracheostomy tube collar/holder, each |
3,552 |
3,334 |
$26K |
| A4388 |
Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each |
527 |
515 |
$22K |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
502 |
475 |
$22K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
3,426 |
3,242 |
$22K |
| A4483 |
Moisture exchanger, disposable, for use with invasive mechanical ventilation |
378 |
320 |
$19K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
1,971 |
1,790 |
$17K |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
2,167 |
2,039 |
$16K |
| A4628 |
Oral and/or oropharyngeal suction catheter, each |
2,212 |
2,010 |
$14K |
| E2402 |
Negative pressure wound therapy electrical pump, stationary or portable |
15 |
14 |
$13K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
91 |
80 |
$12K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
316 |
288 |
$11K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
2,300 |
2,143 |
$10K |
| A6220 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
223 |
196 |
$10K |
| A7002 |
Tubing, used with suction pump, each |
3,168 |
2,841 |
$9K |
| L8501 |
Tracheostomy speaking valve |
125 |
118 |
$8K |
| A4371 |
Ostomy skin barrier, powder, per oz |
3,810 |
3,627 |
$8K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
1,112 |
1,084 |
$5K |
| A4311 |
Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
272 |
268 |
$3K |
| A4367 |
Ostomy belt, each |
1,059 |
1,026 |
$3K |
| A4217 |
Sterile water/saline, 500 ml |
626 |
596 |
$2K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
12 |
12 |
$2K |
| A6550 |
Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories |
14 |
12 |
$2K |
| A4410 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each |
14 |
12 |
$1K |
| A4389 |
Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each |
24 |
24 |
$1K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
51 |
50 |
$1K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
62 |
60 |
$1K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
181 |
156 |
$640.14 |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
50 |
50 |
$636.76 |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
128 |
100 |
$134.06 |
| A7525 |
Tracheostomy mask, each |
72 |
53 |
$78.68 |