| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
19,919 |
19,242 |
$1.01M |
| T4522 |
Adult size brief/diaper med |
11,519 |
11,237 |
$1.01M |
| T4523 |
Adult size brief/diaper lg |
8,880 |
8,669 |
$1.00M |
| T4524 |
Adult size brief/diaper xl |
6,400 |
6,282 |
$744K |
| A4351 |
Straight tip urine catheter |
5,239 |
5,037 |
$705K |
| T4533 |
Youth size brief/diaper |
9,357 |
9,198 |
$695K |
| A4385 |
Ost skn barrier sld ext wear |
11,245 |
10,937 |
$526K |
| A6197 |
Alginate drsg >16 <=48 sq in |
4,610 |
4,448 |
$478K |
| A4353 |
Intermittent urinary cath |
1,078 |
1,028 |
$374K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
1,340 |
1,296 |
$366K |
| A4407 |
Ext wear ost skn barr <=4sq" |
6,282 |
6,090 |
$339K |
| A4362 |
Solid skin barrier |
7,675 |
7,484 |
$317K |
| T4530 |
Ped size brief/diaper lg |
4,219 |
4,147 |
$311K |
| A4425 |
Ost pch drain for barrier fl |
7,234 |
7,078 |
$289K |
| A6212 |
Foam drg <=16 sq in w/border |
4,911 |
4,666 |
$274K |
| A4230 |
Infus insulin pump non needl |
1,497 |
1,484 |
$272K |
| T4535 |
Disposable liner/shield/pad |
8,117 |
7,984 |
$262K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
6,094 |
5,940 |
$256K |
| A5057 |
1 pc ost pou w built-in conv |
1,658 |
1,598 |
$255K |
| A4409 |
Ost skn barr convex <=4 sq i |
6,448 |
6,287 |
$252K |
| T4521 |
Adult size brief/diaper sm |
2,659 |
2,585 |
$225K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
4,166 |
4,068 |
$198K |
| A6196 |
Alginate dressing <=16 sq in |
2,626 |
2,470 |
$180K |
| A4419 |
Ost pch for bar w flange/flt |
3,066 |
2,982 |
$170K |
| A5063 |
Drain ostomy pouch w/flange |
4,567 |
4,464 |
$158K |
| T4537 |
Reusable underpad bed size |
4,820 |
4,664 |
$143K |
| K0553 |
Ther cgm supply allowance |
2,276 |
2,270 |
$139K |
| A6021 |
Collagen dressing <=16 sq in |
2,071 |
1,991 |
$131K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
709 |
683 |
$122K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
1,361 |
1,313 |
$117K |
| A6402 |
Sterile gauze <= 16 sq in |
10,083 |
9,797 |
$116K |
| A5121 |
Solid skin barrier 6x6 |
1,504 |
1,478 |
$113K |
| A4352 |
Coude tip urinary catheter |
252 |
235 |
$108K |
| A4394 |
Ostomy pouch liq deodorant |
6,265 |
6,115 |
$102K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
1,276 |
1,222 |
$97K |
| A6446 |
Conform band s w>=3" <5"/yd |
5,962 |
5,763 |
$94K |
| A4357 |
Bedside drainage bag |
5,029 |
4,835 |
$92K |
| A4239 |
Non-adju cgm supply allow |
1,597 |
1,582 |
$91K |
| A4232 |
Syringe w/needle insulin 3cc |
1,713 |
1,705 |
$78K |
| A4456 |
Adhesive remover, wipes |
10,669 |
10,444 |
$78K |
| A5120 |
Skin barrier, wipe or swab |
12,184 |
11,902 |
$64K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
1,373 |
1,323 |
$57K |
| A4406 |
Pectin based ostomy paste |
3,796 |
3,719 |
$55K |
| A4452 |
Waterproof tape |
6,352 |
6,198 |
$48K |
| A4927 |
Non-sterile gloves |
10,765 |
10,581 |
$44K |
| A4432 |
Os pch urine w bar/fange/tap |
1,997 |
1,798 |
$42K |
| A5056 |
1 pc ost pouch w filter |
559 |
547 |
$42K |
| A6199 |
Alginate drsg wound filler |
455 |
432 |
$36K |
| T4541 |
Large disposable underpad |
1,723 |
1,687 |
$35K |
| A4373 |
Skin barrier with flange |
447 |
422 |
$33K |
| A4349 |
Disposable male external cat |
1,072 |
1,031 |
$31K |
| E0784 |
Ext amb infusn pump insulin |
302 |
302 |
$27K |
| A6449 |
Lt compres band >=3" <5"/yd |
2,856 |
2,744 |
$25K |
| A4450 |
Non-waterproof tape |
5,841 |
5,702 |
$23K |
| A6240 |
Hydrocolld drg filler paste |
396 |
389 |
$22K |
| A4427 |
Ost pch drain/barr lk flng/f |
452 |
437 |
$19K |
| A4216 |
Sterile water/saline, 10 ml |
979 |
969 |
$18K |
| A4371 |
Skin barrier powder per oz |
5,570 |
5,439 |
$18K |
| A4358 |
Urinary leg or abdomen bag |
1,801 |
1,731 |
$18K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
595 |
588 |
$16K |
| A4390 |
Drainable pch ex wear convex |
172 |
164 |
$15K |
| A4367 |
Ostomy belt |
3,271 |
3,198 |
$15K |
| A4424 |
Ost pch drain w bar & filter |
299 |
291 |
$14K |
| A5061 |
Pouch drainable w barrier at |
202 |
200 |
$14K |
| A5054 |
Clsd ostomy pouch w/flange |
214 |
209 |
$14K |
| A6266 |
Impreg gauze no h20/sal/yard |
367 |
356 |
$13K |
| A6457 |
Tubular dressing |
855 |
839 |
$13K |
| A6258 |
Transparent film >16<=48 in |
492 |
476 |
$11K |
| A4416 |
Ost pch clsd w barrier/filtr |
115 |
114 |
$11K |
| T4534 |
Youth size pull-on |
146 |
143 |
$11K |
| A4411 |
Ost skn barr extnd =4sq |
295 |
286 |
$11K |
| A4217 |
Sterile water/saline, 500 ml |
2,100 |
2,034 |
$10K |
| A6248 |
Hydrogel drsg gel filler |
459 |
450 |
$10K |
| A4393 |
Urine pch w ex wear bar conv |
146 |
143 |
$10K |
| A6207 |
Contact layer >16<= 48 sq in |
290 |
283 |
$9K |
| A4412 |
Ost pouch drain high output |
335 |
330 |
$9K |
| A4410 |
Ost skn barr extnd >4 sq |
262 |
257 |
$9K |
| T4526 |
Adult size pull-on med |
214 |
212 |
$9K |
| A6454 |
Self-adher band w>=3" <5"/yd |
729 |
704 |
$8K |
| A6216 |
Non-sterile gauze<=16 sq in |
2,557 |
2,443 |
$8K |
| A4310 |
Insert tray w/o bag/cath |
880 |
839 |
$6K |
| T4527 |
Adult size pull-on lg |
150 |
150 |
$5K |
| A4430 |
Ost urine pch w b/bltin conv |
98 |
95 |
$5K |
| A4396 |
Peristomal hernia supprt blt |
180 |
178 |
$5K |
| A6211 |
Foam drg > 48 sq in w/o brdr |
12 |
12 |
$5K |
| A6219 |
Gauze <= 16 sq in w/border |
813 |
786 |
$5K |
| A6443 |
Conform band n/s w>=3"<5"/yd |
1,431 |
1,388 |
$5K |
| T4528 |
Adult size pull-on xl |
122 |
121 |
$5K |
| A4402 |
Lubricant per ounce |
2,259 |
2,204 |
$5K |
| A4344 |
Cath indw foley 2 way silicn |
285 |
258 |
$5K |
| A6452 |
High compres band w>=3"<5"yd |
185 |
167 |
$4K |
| A4338 |
Indwelling catheter latex |
671 |
637 |
$4K |
| A6441 |
Pad band w>=3" <5"/yd |
461 |
423 |
$4K |
| A6450 |
Lt compres band >=5"/yd |
320 |
307 |
$4K |
| A4369 |
Skin barrier liquid per oz |
801 |
764 |
$3K |
| A4408 |
Ext wear ost skn barr >4sq" |
54 |
51 |
$3K |
| A4389 |
Drainable pch w st wear barr |
69 |
64 |
$3K |
| A4388 |
Drainable pch w ex wear barr |
84 |
81 |
$3K |
| A4333 |
Urinary cath anchor device |
346 |
328 |
$3K |
| A4320 |
Irrigation tray |
304 |
292 |
$2K |
| A6217 |
Non-sterile gauze>16<=48 sq |
401 |
390 |
$2K |
| A4322 |
Irrigation syringe |
349 |
346 |
$2K |
| A4224 |
Supply insulin inf cath/wk |
95 |
95 |
$2K |
| A6220 |
Gauze >16 <=48 sq in w/bordr |
82 |
80 |
$2K |
| A4455 |
Adhesive remover per ounce |
568 |
544 |
$2K |
| A4404 |
Ostomy ring each |
137 |
129 |
$2K |
| A6218 |
Non-sterile gauze > 48 sq in |
186 |
180 |
$1K |
| A4405 |
Nonpectin based ostomy paste |
193 |
178 |
$1K |
| A6251 |
Absorpt drg <=16 sq in w/o b |
89 |
84 |
$1K |
| A4245 |
Alcohol wipes per box |
342 |
331 |
$990.73 |
| A4423 |
Ost pch for bar w lk fl/fltr |
12 |
12 |
$985.86 |
| A4225 |
Sup/ext insulin inf pump syr |
145 |
141 |
$951.35 |
| A6403 |
Sterile gauze>16 <= 48 sq in |
60 |
55 |
$923.13 |
| A6456 |
Zinc paste band w >=3"<5"/yd |
53 |
52 |
$833.74 |
| A4335 |
Incontinence supply |
74 |
74 |
$552.73 |
| A6250 |
Skin seal protect moisturizr |
75 |
75 |
$405.12 |
| A4331 |
Extension drainage tubing |
82 |
79 |
$361.20 |
| A4334 |
Urinary cath leg strap |
42 |
40 |
$127.39 |
| A6442 |
Conform band n/s w<3"/yd |
36 |
34 |
$88.97 |
| A4363 |
Ostomy clamp, replacement |
12 |
12 |
$20.25 |