| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
1,705 |
1,509 |
$237K |
| 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 |
1,156 |
1,056 |
$214K |
| 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 |
2,385 |
2,245 |
$151K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,088 |
884 |
$127K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,972 |
1,633 |
$89K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
680 |
589 |
$66K |
| A4927 |
Gloves, non-sterile, per 100 |
4,110 |
3,555 |
$64K |
| A4452 |
Tape, waterproof, per 18 square inches |
3,293 |
3,043 |
$61K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
2,015 |
1,843 |
$53K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,849 |
4,675 |
$36K |
| A4217 |
Sterile water/saline, 500 ml |
4,084 |
3,749 |
$33K |
| 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 |
788 |
706 |
$32K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
616 |
586 |
$31K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
291 |
269 |
$30K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
217 |
209 |
$30K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
1,935 |
1,507 |
$29K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
201 |
191 |
$29K |
| 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 |
165 |
138 |
$24K |
| K0001 |
Standard wheelchair |
4,134 |
3,731 |
$22K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
240 |
224 |
$19K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,699 |
1,516 |
$12K |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
695 |
653 |
$10K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
794 |
563 |
$9K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
2,108 |
1,870 |
$8K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,271 |
1,204 |
$7K |
| A5120 |
Skin barrier, wipes or swabs, each |
605 |
586 |
$6K |
| E0570 |
Nebulizer, with compressor |
1,234 |
1,105 |
$4K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
55 |
51 |
$3K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
169 |
167 |
$3K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
966 |
839 |
$3K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
35 |
29 |
$2K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
14 |
12 |
$1K |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
14 |
14 |
$969.60 |
| A6240 |
Hydrocolloid dressing, wound filler, paste, sterile, per ounce |
13 |
13 |
$956.80 |
| A4218 |
Sterile saline or water, metered dose dispenser, 10 ml |
68 |
66 |
$716.00 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
134 |
130 |
$614.46 |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
13 |
12 |
$577.60 |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
33 |
24 |
$499.36 |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
41 |
36 |
$259.56 |
| A4456 |
Adhesive remover, wipes, any type, each |
12 |
12 |
$125.40 |
| E0305 |
Bed side rails, half length |
191 |
187 |
$0.00 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
20 |
16 |
$0.00 |
| E0272 |
Mattress, foam rubber |
200 |
197 |
$0.00 |