| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4353 |
Intermittent urinary cath |
1,470 |
1,233 |
$818K |
| E0603 |
Electric breast pump |
5,107 |
5,052 |
$606K |
| A9276 |
Disposable sensor, cgm sys |
1,068 |
1,048 |
$399K |
| K0553 |
Ther cgm supply allowance |
1,368 |
1,328 |
$346K |
| A9274 |
Ext amb insulin delivery sys |
766 |
742 |
$256K |
| A4409 |
Ost skn barr convex <=4 sq i |
2,267 |
2,004 |
$234K |
| A4351 |
Straight tip urine catheter |
1,587 |
1,343 |
$230K |
| A4239 |
Non-adju cgm supply allow |
951 |
849 |
$183K |
| A4407 |
Ext wear ost skn barr <=4sq" |
898 |
793 |
$138K |
| T4534 |
Youth size pull-on |
1,395 |
1,316 |
$126K |
| A4230 |
Infus insulin pump non needl |
1,418 |
1,319 |
$119K |
| A4385 |
Ost skn barrier sld ext wear |
2,928 |
2,630 |
$102K |
| A4362 |
Solid skin barrier |
2,058 |
1,862 |
$97K |
| A4425 |
Ost pch drain for barrier fl |
2,424 |
2,172 |
$88K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
934 |
791 |
$84K |
| A6197 |
Alginate drsg >16 <=48 sq in |
270 |
196 |
$53K |
| A4253 |
Blood glucose/reagent strips |
1,163 |
1,123 |
$49K |
| A4554 |
Disposable underpads |
1,080 |
903 |
$47K |
| A4335 |
Incontinence supply |
486 |
467 |
$44K |
| E0784 |
Ext amb infusn pump insulin |
13 |
13 |
$39K |
| A4406 |
Pectin based ostomy paste |
1,615 |
1,449 |
$37K |
| A5063 |
Drain ostomy pouch w/flange |
1,341 |
1,191 |
$36K |
| A4456 |
Adhesive remover, wipes |
3,317 |
2,964 |
$33K |
| A5120 |
Skin barrier, wipe or swab |
3,519 |
3,158 |
$30K |
| A4394 |
Ostomy pouch liq deodorant |
2,021 |
1,775 |
$26K |
| A6212 |
Foam drg <=16 sq in w/border |
486 |
316 |
$26K |
| T4526 |
Adult size pull-on med |
393 |
354 |
$22K |
| A4357 |
Bedside drainage bag |
1,157 |
1,006 |
$21K |
| A4927 |
Non-sterile gloves |
2,141 |
1,974 |
$21K |
| T4528 |
Adult size pull-on xl |
207 |
163 |
$20K |
| A5121 |
Solid skin barrier 6x6 |
243 |
226 |
$17K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
172 |
136 |
$15K |
| A4232 |
Syringe w/needle insulin 3cc |
1,380 |
1,288 |
$14K |
| A4452 |
Waterproof tape |
942 |
827 |
$13K |
| A6196 |
Alginate dressing <=16 sq in |
240 |
167 |
$12K |
| A4371 |
Skin barrier powder per oz |
1,924 |
1,760 |
$11K |
| A4358 |
Urinary leg or abdomen bag |
576 |
502 |
$9K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
35 |
25 |
$8K |
| A6446 |
Conform band s w>=3" <5"/yd |
357 |
279 |
$6K |
| A4259 |
Lancets per box |
850 |
827 |
$5K |
| A6021 |
Collagen dressing <=16 sq in |
14 |
13 |
$3K |
| T4535 |
Disposable liner/shield/pad |
244 |
229 |
$3K |
| A4450 |
Non-waterproof tape |
615 |
519 |
$3K |
| A6216 |
Non-sterile gauze<=16 sq in |
275 |
226 |
$2K |
| A6402 |
Sterile gauze <= 16 sq in |
430 |
342 |
$2K |
| A4349 |
Disposable male external cat |
44 |
38 |
$2K |
| A4369 |
Skin barrier liquid per oz |
511 |
463 |
$2K |
| T4530 |
Ped size brief/diaper lg |
45 |
37 |
$2K |
| T4522 |
Adult size brief/diaper med |
41 |
27 |
$2K |
| A4367 |
Ostomy belt |
646 |
575 |
$2K |
| A6250 |
Skin seal protect moisturizr |
272 |
261 |
$1K |
| T4541 |
Large disposable underpad |
382 |
362 |
$1K |
| T4527 |
Adult size pull-on lg |
67 |
66 |
$1K |
| A5061 |
Pouch drainable w barrier at |
14 |
13 |
$929.13 |
| A6449 |
Lt compres band >=3" <5"/yd |
18 |
13 |
$924.00 |
| A4432 |
Os pch urine w bar/fange/tap |
25 |
24 |
$686.40 |
| A4424 |
Ost pch drain w bar & filter |
12 |
12 |
$622.37 |
| A4455 |
Adhesive remover per ounce |
166 |
150 |
$614.68 |
| A4402 |
Lubricant per ounce |
33 |
26 |
$153.26 |
| A4225 |
Sup/ext insulin inf pump syr |
30 |
25 |
$144.68 |
| A4224 |
Supply insulin inf cath/wk |
15 |
14 |
$63.60 |