| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A9276 |
Disposable sensor, cgm sys |
48,395 |
38,958 |
$13.27M |
| A9277 |
External transmitter, cgm |
9,162 |
7,838 |
$4.32M |
| K0553 |
Ther cgm supply allowance |
21,564 |
18,019 |
$3.97M |
| A9274 |
Ext amb insulin delivery sys |
7,809 |
6,713 |
$3.81M |
| E0784 |
Ext amb infusn pump insulin |
2,727 |
1,939 |
$3.24M |
| A4239 |
Non-adju cgm supply allow |
14,986 |
10,134 |
$2.52M |
| A6197 |
Alginate drsg >16 <=48 sq in |
6,772 |
5,268 |
$1.58M |
| A9278 |
External receiver, cgm sys |
2,504 |
2,117 |
$893K |
| A4224 |
Supply insulin inf cath/wk |
25,621 |
17,592 |
$869K |
| A4385 |
Ost skn barrier sld ext wear |
12,444 |
9,749 |
$720K |
| A6196 |
Alginate dressing <=16 sq in |
6,894 |
5,425 |
$644K |
| A4409 |
Ost skn barr convex <=4 sq i |
8,629 |
7,037 |
$585K |
| A6021 |
Collagen dressing <=16 sq in |
3,475 |
2,868 |
$538K |
| A4230 |
Infus insulin pump non needl |
10,911 |
7,935 |
$502K |
| A4351 |
Straight tip urine catheter |
4,547 |
3,418 |
$456K |
| A4225 |
Sup/ext insulin inf pump syr |
28,063 |
17,417 |
$446K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
3,186 |
2,426 |
$441K |
| A4407 |
Ext wear ost skn barr <=4sq" |
4,249 |
3,344 |
$393K |
| A6212 |
Foam drg <=16 sq in w/border |
5,523 |
4,319 |
$346K |
| A4425 |
Ost pch drain for barrier fl |
7,705 |
6,178 |
$304K |
| A4362 |
Solid skin barrier |
7,208 |
5,909 |
$256K |
| A4394 |
Ostomy pouch liq deodorant |
8,586 |
6,974 |
$247K |
| A6449 |
Lt compres band >=3" <5"/yd |
2,779 |
2,232 |
$209K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
4,042 |
3,306 |
$205K |
| A4232 |
Syringe w/needle insulin 3cc |
7,132 |
6,177 |
$197K |
| K0554 |
Ther cgm receiver/monitor |
1,515 |
999 |
$193K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
1,634 |
1,309 |
$168K |
| A6446 |
Conform band s w>=3" <5"/yd |
7,693 |
6,097 |
$159K |
| A4353 |
Intermittent urinary cath |
296 |
236 |
$151K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
2,877 |
2,265 |
$148K |
| A4352 |
Coude tip urinary catheter |
355 |
277 |
$135K |
| A5063 |
Drain ostomy pouch w/flange |
4,503 |
3,774 |
$128K |
| E0603 |
Electric breast pump |
1,051 |
959 |
$110K |
| T4541 |
Large disposable underpad |
5,089 |
3,431 |
$110K |
| A5121 |
Solid skin barrier 6x6 |
1,512 |
1,119 |
$100K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
1,464 |
863 |
$99K |
| E2103 |
Non-adju cgm receiver/mon |
593 |
394 |
$96K |
| A4419 |
Ost pch for bar w flange/flt |
1,982 |
1,462 |
$92K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
1,816 |
1,452 |
$88K |
| A5057 |
1 pc ost pou w built-in conv |
697 |
555 |
$83K |
| T4543 |
Adult disp brief/diap abv xl |
881 |
537 |
$78K |
| A4456 |
Adhesive remover, wipes |
10,762 |
8,743 |
$77K |
| A4406 |
Pectin based ostomy paste |
5,897 |
4,836 |
$75K |
| T4528 |
Adult size pull-on xl |
1,713 |
1,021 |
$69K |
| T4534 |
Youth size pull-on |
1,294 |
797 |
$68K |
| T4527 |
Adult size pull-on lg |
1,554 |
1,028 |
$66K |
| A6199 |
Alginate drsg wound filler |
851 |
666 |
$63K |
| A4432 |
Os pch urine w bar/fange/tap |
1,862 |
1,453 |
$62K |
| A5056 |
1 pc ost pouch w filter |
849 |
737 |
$61K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
1,669 |
1,369 |
$56K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
1,902 |
1,557 |
$53K |
| A4927 |
Non-sterile gloves |
5,599 |
4,125 |
$50K |
| A5120 |
Skin barrier, wipe or swab |
12,627 |
10,064 |
$46K |
| T4526 |
Adult size pull-on med |
1,218 |
711 |
$45K |
| A6402 |
Sterile gauze <= 16 sq in |
7,459 |
6,150 |
$39K |
| A4520 |
Incontinence garment anytype |
1,186 |
750 |
$39K |
| T4524 |
Adult size brief/diaper xl |
870 |
567 |
$39K |
| A4452 |
Waterproof tape |
7,900 |
6,272 |
$34K |
| A6266 |
Impreg gauze no h20/sal/yard |
460 |
355 |
$32K |
| A4357 |
Bedside drainage bag |
4,257 |
3,218 |
$32K |
| A6454 |
Self-adher band w>=3" <5"/yd |
916 |
680 |
$32K |
| T4523 |
Adult size brief/diaper lg |
640 |
377 |
$26K |
| A4371 |
Skin barrier powder per oz |
6,973 |
5,695 |
$25K |
| A4335 |
Incontinence supply |
2,558 |
1,633 |
$23K |
| A6207 |
Contact layer >16<= 48 sq in |
552 |
417 |
$21K |
| A6216 |
Non-sterile gauze<=16 sq in |
6,686 |
5,084 |
$20K |
| T4530 |
Ped size brief/diaper lg |
514 |
394 |
$20K |
| T4522 |
Adult size brief/diaper med |
541 |
350 |
$19K |
| A4427 |
Ost pch drain/barr lk flng/f |
645 |
527 |
$18K |
| T4535 |
Disposable liner/shield/pad |
1,517 |
1,038 |
$14K |
| A4367 |
Ostomy belt |
3,752 |
3,157 |
$13K |
| A6545 |
Grad com non-elastic bk surg |
710 |
312 |
$13K |
| A6450 |
Lt compres band >=5"/yd |
367 |
261 |
$13K |
| A6250 |
Skin seal protect moisturizr |
834 |
507 |
$11K |
| A4373 |
Skin barrier with flange |
212 |
144 |
$11K |
| K0552 |
Sup/ext non-ins inf pump syr |
700 |
272 |
$11K |
| A6219 |
Gauze <= 16 sq in w/border |
617 |
534 |
$10K |
| A6457 |
Tubular dressing |
1,253 |
976 |
$9K |
| A4554 |
Disposable underpads |
809 |
363 |
$8K |
| A6443 |
Conform band n/s w>=3"<5"/yd |
659 |
551 |
$8K |
| A4369 |
Skin barrier liquid per oz |
2,885 |
2,360 |
$7K |
| A4450 |
Non-waterproof tape |
4,198 |
3,462 |
$7K |
| A6452 |
High compres band w>=3"<5"yd |
80 |
63 |
$7K |
| A4358 |
Urinary leg or abdomen bag |
1,097 |
763 |
$7K |
| A4455 |
Adhesive remover per ounce |
2,070 |
1,696 |
$7K |
| A4424 |
Ost pch drain w bar & filter |
174 |
138 |
$6K |
| A4349 |
Disposable male external cat |
297 |
188 |
$6K |
| A4310 |
Insert tray w/o bag/cath |
1,074 |
795 |
$5K |
| A6248 |
Hydrogel drsg gel filler |
167 |
146 |
$5K |
| A4332 |
Lube sterile packet |
607 |
479 |
$5K |
| A4338 |
Indwelling catheter latex |
851 |
622 |
$5K |
| A6010 |
Collagen based wound filler |
17 |
12 |
$3K |
| E1399 |
Durable medical equipment mi |
500 |
250 |
$3K |
| T4537 |
Reusable underpad bed size |
253 |
218 |
$3K |
| A4410 |
Ost skn barr extnd >4 sq |
18 |
14 |
$3K |
| A4217 |
Sterile water/saline, 500 ml |
645 |
541 |
$2K |
| A6441 |
Pad band w>=3" <5"/yd |
160 |
114 |
$2K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
33 |
28 |
$2K |
| A4344 |
Cath indw foley 2 way silicn |
106 |
80 |
$1K |
| A4221 |
Supp non-insulin inf cath/wk |
47 |
22 |
$924.80 |
| A4333 |
Urinary cath anchor device |
156 |
128 |
$910.41 |
| A5061 |
Pouch drainable w barrier at |
12 |
12 |
$757.81 |
| A4322 |
Irrigation syringe |
212 |
159 |
$740.77 |
| A4364 |
Adhesive, liquid or equal |
136 |
107 |
$695.34 |
| A4396 |
Peristomal hernia supprt blt |
36 |
28 |
$622.57 |
| A9270 |
Non-covered item or service |
1,343 |
473 |
$603.95 |
| A4412 |
Ost pouch drain high output |
15 |
12 |
$363.96 |
| A6257 |
Transparent film <= 16 sq in |
35 |
25 |
$342.43 |
| A6442 |
Conform band n/s w<3"/yd |
56 |
37 |
$302.94 |
| A4402 |
Lubricant per ounce |
72 |
62 |
$296.49 |
| A6445 |
Conform band s w <3"/yd |
15 |
13 |
$221.61 |
| A4216 |
Sterile water/saline, 10 ml |
44 |
39 |
$208.21 |
| A4405 |
Nonpectin based ostomy paste |
16 |
13 |
$93.48 |
| A6217 |
Non-sterile gauze>16<=48 sq |
14 |
12 |
$44.12 |