| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
9,446 |
8,719 |
$1.42M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
8,247 |
8,026 |
$1.38M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
9,818 |
9,611 |
$1.26M |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
26,583 |
25,810 |
$1.06M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
7,617 |
7,428 |
$1.06M |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
2,412 |
2,225 |
$1.05M |
| A4927 |
Gloves, non-sterile, per 100 |
47,584 |
45,158 |
$944K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
6,536 |
6,249 |
$778K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
12,297 |
11,728 |
$655K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
5,866 |
5,651 |
$648K |
| T4541 |
Incontinence product, disposable underpad, large, each |
25,927 |
24,952 |
$593K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
3,617 |
3,517 |
$545K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
4,371 |
4,172 |
$500K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
2,916 |
2,830 |
$404K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
1,364 |
1,310 |
$403K |
| B4100 |
Food thickener, administered orally, per ounce |
6,421 |
6,065 |
$333K |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
1,260 |
1,179 |
$301K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
1,096 |
1,032 |
$211K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
1,252 |
1,195 |
$181K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
1,187 |
1,112 |
$150K |
| A4500 |
Surgical stockings below knee length, each |
2,228 |
2,190 |
$122K |
| E1399 |
Durable medical equipment, miscellaneous |
394 |
364 |
$111K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
7,679 |
7,653 |
$87K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,371 |
1,272 |
$63K |
| A4217 |
Sterile water/saline, 500 ml |
1,896 |
1,667 |
$62K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
557 |
478 |
$57K |
| A4322 |
Irrigation syringe, bulb or piston, each |
1,022 |
967 |
$35K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
3,393 |
3,206 |
$35K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,215 |
1,143 |
$35K |
| 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 |
91 |
89 |
$34K |
| A4332 |
Lubricant, individual sterile packet, each |
3,722 |
3,558 |
$33K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,440 |
1,255 |
$18K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
371 |
341 |
$16K |
| A4402 |
Lubricant, per ounce |
2,424 |
2,205 |
$11K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
558 |
517 |
$11K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
83 |
76 |
$9K |
| A4335 |
Incontinence supply; miscellaneous |
618 |
503 |
$9K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
141 |
129 |
$8K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
193 |
182 |
$8K |
| E0325 |
Urinal; male, jug-type, any material |
1,456 |
1,398 |
$7K |
| A4452 |
Tape, waterproof, per 18 square inches |
723 |
623 |
$7K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
1,194 |
1,072 |
$7K |
| A5120 |
Skin barrier, wipes or swabs, each |
1,095 |
1,003 |
$6K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
35 |
29 |
$5K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
711 |
667 |
$5K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
114 |
104 |
$3K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
745 |
628 |
$3K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
137 |
137 |
$2K |
| A4456 |
Adhesive remover, wipes, any type, each |
313 |
294 |
$2K |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
75 |
63 |
$2K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
50 |
49 |
$2K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
81 |
75 |
$1K |
| A4554 |
Disposable underpads, all sizes |
89 |
84 |
$965.84 |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
232 |
227 |
$892.23 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
30 |
26 |
$860.80 |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
12 |
12 |
$675.66 |
| A4553 |
Non-disposable underpads, all sizes |
12 |
12 |
$520.80 |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
85 |
74 |
$510.75 |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
219 |
189 |
$196.71 |