| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
1,170 |
922 |
$24K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
700 |
550 |
$22K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
807 |
649 |
$15K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
320 |
276 |
$13K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
533 |
449 |
$9K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
336 |
263 |
$4K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
784 |
622 |
$4K |
| A4456 |
Adhesive remover, wipes, any type, each |
1,220 |
975 |
$4K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
607 |
483 |
$4K |
| A5120 |
Skin barrier, wipes or swabs, each |
1,182 |
939 |
$3K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
89 |
61 |
$2K |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
25 |
24 |
$2K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
309 |
225 |
$1K |
| A4371 |
Ostomy skin barrier, powder, per oz |
667 |
545 |
$966.52 |
| A4367 |
Ostomy belt, each |
277 |
242 |
$665.33 |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
81 |
52 |
$532.73 |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
383 |
308 |
$529.26 |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
143 |
105 |
$127.36 |
| A4452 |
Tape, waterproof, per 18 square inches |
13 |
12 |
$67.85 |