| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4353 |
Intermittent urinary catheter, with insertion supplies |
1,470 |
1,233 |
$818K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
5,107 |
5,052 |
$606K |
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
1,068 |
1,048 |
$399K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
1,368 |
1,328 |
$346K |
| A9274 |
External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories |
766 |
742 |
$256K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
2,267 |
2,004 |
$234K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,587 |
1,343 |
$230K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
951 |
849 |
$183K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
898 |
793 |
$138K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
1,395 |
1,316 |
$126K |
| A4230 |
Infusion set for external insulin pump, non needle cannula type |
1,418 |
1,319 |
$119K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
2,928 |
2,630 |
$102K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
2,058 |
1,862 |
$97K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
2,424 |
2,172 |
$88K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
934 |
791 |
$84K |
| 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 |
270 |
196 |
$53K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,163 |
1,123 |
$49K |
| A4554 |
Disposable underpads, all sizes |
1,080 |
903 |
$47K |
| A4335 |
Incontinence supply; miscellaneous |
486 |
467 |
$44K |
| E0784 |
External ambulatory infusion pump, insulin |
13 |
13 |
$39K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
1,615 |
1,449 |
$37K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
1,341 |
1,191 |
$36K |
| A4456 |
Adhesive remover, wipes, any type, each |
3,317 |
2,964 |
$33K |
| A5120 |
Skin barrier, wipes or swabs, each |
3,519 |
3,158 |
$30K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
2,021 |
1,775 |
$26K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
486 |
316 |
$26K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
393 |
354 |
$22K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
1,157 |
1,006 |
$21K |
| A4927 |
Gloves, non-sterile, per 100 |
2,141 |
1,974 |
$21K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
207 |
163 |
$20K |
| A5121 |
Skin barrier; solid, 6 x 6 or equivalent, each |
243 |
226 |
$17K |
| 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 |
172 |
136 |
$15K |
| A4232 |
Syringe with needle for external insulin pump, sterile, 3 cc |
1,380 |
1,288 |
$14K |
| A4452 |
Tape, waterproof, per 18 square inches |
942 |
827 |
$13K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
240 |
167 |
$12K |
| A4371 |
Ostomy skin barrier, powder, per oz |
1,924 |
1,760 |
$11K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
576 |
502 |
$9K |
| A6210 |
Foam 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 |
35 |
25 |
$8K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
357 |
279 |
$6K |
| A4259 |
Lancets, per box of 100 |
850 |
827 |
$5K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
14 |
13 |
$3K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
244 |
229 |
$3K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
615 |
519 |
$3K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
275 |
226 |
$2K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
430 |
342 |
$2K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
44 |
38 |
$2K |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
511 |
463 |
$2K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
45 |
37 |
$2K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
41 |
27 |
$2K |
| A4367 |
Ostomy belt, each |
646 |
575 |
$2K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
272 |
261 |
$1K |
| T4541 |
Incontinence product, disposable underpad, large, each |
382 |
362 |
$1K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
67 |
66 |
$1K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
14 |
13 |
$929.13 |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
18 |
13 |
$924.00 |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
25 |
24 |
$686.40 |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
12 |
12 |
$622.37 |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
166 |
150 |
$614.68 |
| A4402 |
Lubricant, per ounce |
33 |
26 |
$153.26 |
| A4225 |
Supplies for external insulin infusion pump, syringe type cartridge, sterile, each |
30 |
25 |
$144.68 |
| A4224 |
Supplies for maintenance of insulin infusion catheter, per week |
15 |
14 |
$63.60 |