| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
19,919 |
19,242 |
$1.01M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
11,519 |
11,237 |
$1.01M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
8,880 |
8,669 |
$1.00M |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
6,400 |
6,282 |
$744K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
5,239 |
5,037 |
$705K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
9,357 |
9,198 |
$695K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
11,245 |
10,937 |
$526K |
| 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 |
4,610 |
4,448 |
$478K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
1,078 |
1,028 |
$374K |
| 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 |
1,340 |
1,296 |
$366K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
6,282 |
6,090 |
$339K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
7,675 |
7,484 |
$317K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
4,219 |
4,147 |
$311K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
7,234 |
7,078 |
$289K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
4,911 |
4,666 |
$274K |
| A4230 |
Infusion set for external insulin pump, non needle cannula type |
1,497 |
1,484 |
$272K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
8,117 |
7,984 |
$262K |
| 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 |
6,094 |
5,940 |
$256K |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
1,658 |
1,598 |
$255K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
6,448 |
6,287 |
$252K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
2,659 |
2,585 |
$225K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
4,166 |
4,068 |
$198K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
2,626 |
2,470 |
$180K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
3,066 |
2,982 |
$170K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
4,567 |
4,464 |
$158K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
4,820 |
4,664 |
$143K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
2,276 |
2,270 |
$139K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
2,071 |
1,991 |
$131K |
| 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 |
709 |
683 |
$122K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,361 |
1,313 |
$117K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
10,083 |
9,797 |
$116K |
| A5121 |
Skin barrier; solid, 6 x 6 or equivalent, each |
1,504 |
1,478 |
$113K |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
252 |
235 |
$108K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
6,265 |
6,115 |
$102K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
1,276 |
1,222 |
$97K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
5,962 |
5,763 |
$94K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
5,029 |
4,835 |
$92K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
1,597 |
1,582 |
$91K |
| A4232 |
Syringe with needle for external insulin pump, sterile, 3 cc |
1,713 |
1,705 |
$78K |
| A4456 |
Adhesive remover, wipes, any type, each |
10,669 |
10,444 |
$78K |
| A5120 |
Skin barrier, wipes or swabs, each |
12,184 |
11,902 |
$64K |
| 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 |
1,373 |
1,323 |
$57K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
3,796 |
3,719 |
$55K |
| A4452 |
Tape, waterproof, per 18 square inches |
6,352 |
6,198 |
$48K |
| A4927 |
Gloves, non-sterile, per 100 |
10,765 |
10,581 |
$44K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
1,997 |
1,798 |
$42K |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
559 |
547 |
$42K |
| A6199 |
Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches |
455 |
432 |
$36K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,723 |
1,687 |
$35K |
| A4373 |
Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each |
447 |
422 |
$33K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
1,072 |
1,031 |
$31K |
| E0784 |
External ambulatory infusion pump, insulin |
302 |
302 |
$27K |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
2,856 |
2,744 |
$25K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
5,841 |
5,702 |
$23K |
| A6240 |
Hydrocolloid dressing, wound filler, paste, sterile, per ounce |
396 |
389 |
$22K |
| A4427 |
Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each |
452 |
437 |
$19K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
979 |
969 |
$18K |
| A4371 |
Ostomy skin barrier, powder, per oz |
5,570 |
5,439 |
$18K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
1,801 |
1,731 |
$18K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
595 |
588 |
$16K |
| A4390 |
Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each |
172 |
164 |
$15K |
| A4367 |
Ostomy belt, each |
3,271 |
3,198 |
$15K |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
299 |
291 |
$14K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
202 |
200 |
$14K |
| A5054 |
Ostomy pouch, closed; for use on barrier with flange (2 piece), each |
214 |
209 |
$14K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
367 |
356 |
$13K |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
855 |
839 |
$13K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
492 |
476 |
$11K |
| A4416 |
Ostomy pouch, closed, with barrier attached, with filter (1 piece), each |
115 |
114 |
$11K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
146 |
143 |
$11K |
| A4411 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in convexity, each |
295 |
286 |
$11K |
| A4217 |
Sterile water/saline, 500 ml |
2,100 |
2,034 |
$10K |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
459 |
450 |
$10K |
| A4393 |
Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity (1 piece), each |
146 |
143 |
$10K |
| A6207 |
Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
290 |
283 |
$9K |
| A4412 |
Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), without filter, each |
335 |
330 |
$9K |
| A4410 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each |
262 |
257 |
$9K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
214 |
212 |
$9K |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
729 |
704 |
$8K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,557 |
2,443 |
$8K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
880 |
839 |
$6K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
150 |
150 |
$5K |
| A4430 |
Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each |
98 |
95 |
$5K |
| A4396 |
Ostomy belt with peristomal hernia support |
180 |
178 |
$5K |
| A6211 |
Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
12 |
12 |
$5K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
813 |
786 |
$5K |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
1,431 |
1,388 |
$5K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
122 |
121 |
$5K |
| A4402 |
Lubricant, per ounce |
2,259 |
2,204 |
$5K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
285 |
258 |
$5K |
| A6452 |
High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard |
185 |
167 |
$4K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
671 |
637 |
$4K |
| A6441 |
Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard |
461 |
423 |
$4K |
| A6450 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard |
320 |
307 |
$4K |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
801 |
764 |
$3K |
| A4408 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, with built-in convexity, larger than 4 x 4 inches, each |
54 |
51 |
$3K |
| A4389 |
Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each |
69 |
64 |
$3K |
| A4388 |
Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each |
84 |
81 |
$3K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
346 |
328 |
$3K |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
304 |
292 |
$2K |
| A6217 |
Gauze, non-impregnated, non-sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
401 |
390 |
$2K |
| A4322 |
Irrigation syringe, bulb or piston, each |
349 |
346 |
$2K |
| A4224 |
Supplies for maintenance of insulin infusion catheter, per week |
95 |
95 |
$2K |
| 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 |
82 |
80 |
$2K |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
568 |
544 |
$2K |
| A4404 |
Ostomy ring, each |
137 |
129 |
$2K |
| A6218 |
Gauze, non-impregnated, non-sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
186 |
180 |
$1K |
| A4405 |
Ostomy skin barrier, non-pectin based, paste, per ounce |
193 |
178 |
$1K |
| A6251 |
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
89 |
84 |
$1K |
| A4245 |
Alcohol wipes, per box |
342 |
331 |
$990.73 |
| A4423 |
Ostomy pouch, closed; for use on barrier with locking flange, with filter (2 piece), each |
12 |
12 |
$985.86 |
| A4225 |
Supplies for external insulin infusion pump, syringe type cartridge, sterile, each |
145 |
141 |
$951.35 |
| A6403 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing |
60 |
55 |
$923.13 |
| A6456 |
Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
53 |
52 |
$833.74 |
| A4335 |
Incontinence supply; miscellaneous |
74 |
74 |
$552.73 |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
75 |
75 |
$405.12 |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
82 |
79 |
$361.20 |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
42 |
40 |
$127.39 |
| A6442 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width less than three inches, per yard |
36 |
34 |
$88.97 |
| A4363 |
Ostomy clamp, any type, replacement only, each |
12 |
12 |
$20.25 |