| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
33,848 |
24,812 |
$2.66M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
24,625 |
18,222 |
$2.06M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
27,831 |
20,592 |
$2.03M |
| A4554 |
Disposable underpads, all sizes |
36,845 |
33,835 |
$1.80M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
14,905 |
10,404 |
$1.16M |
| A4553 |
Non-disposable underpads, all sizes |
6,084 |
5,756 |
$1.07M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
14,605 |
9,685 |
$1.05M |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
10,378 |
7,572 |
$828K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
9,735 |
6,589 |
$795K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
10,393 |
7,718 |
$656K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
9,455 |
6,613 |
$650K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
3,819 |
2,652 |
$245K |
| 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 |
1,973 |
1,447 |
$220K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,434 |
1,568 |
$197K |
| 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 |
3,126 |
2,045 |
$190K |
| 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 |
2,036 |
1,416 |
$184K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
3,608 |
2,478 |
$167K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,414 |
1,194 |
$79K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,569 |
1,795 |
$77K |
| 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 |
239 |
212 |
$63K |
| A6260 |
Wound cleansers, any type, any size |
2,403 |
2,219 |
$51K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
4,276 |
3,460 |
$37K |
| A4452 |
Tape, waterproof, per 18 square inches |
3,450 |
2,763 |
$30K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
911 |
808 |
$28K |
| 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 |
285 |
243 |
$22K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
662 |
487 |
$15K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
700 |
522 |
$14K |
| A4322 |
Irrigation syringe, bulb or piston, each |
495 |
462 |
$14K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,861 |
1,602 |
$11K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
5,567 |
4,127 |
$10K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
333 |
249 |
$9K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
82 |
65 |
$9K |
| 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 |
801 |
686 |
$8K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
2,864 |
2,167 |
$8K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,547 |
1,225 |
$5K |
| A5120 |
Skin barrier, wipes or swabs, each |
1,088 |
853 |
$5K |
| A4311 |
Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
862 |
682 |
$5K |
| B4100 |
Food thickener, administered orally, per ounce |
56 |
54 |
$4K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
463 |
378 |
$4K |
| A4456 |
Adhesive remover, wipes, any type, each |
757 |
566 |
$3K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
27 |
25 |
$2K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
4,160 |
3,415 |
$2K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
38 |
27 |
$2K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
133 |
101 |
$2K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
25 |
24 |
$2K |
| A4402 |
Lubricant, per ounce |
602 |
416 |
$2K |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
1,412 |
1,176 |
$1K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
52 |
37 |
$1K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
22 |
13 |
$487.40 |
| E0776 |
Iv pole |
16 |
13 |
$200.13 |
| A4371 |
Ostomy skin barrier, powder, per oz |
34 |
25 |
$69.94 |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
15 |
12 |
$61.15 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
29 |
24 |
$37.51 |