| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6197 |
Alginate drsg >16 <=48 sq in |
42,126 |
36,461 |
$9.88M |
| K0553 |
Ther cgm supply allowance |
63,176 |
58,591 |
$9.05M |
| A9276 |
Disposable sensor, cgm sys |
36,202 |
26,167 |
$7.57M |
| E0784 |
Ext amb infusn pump insulin |
4,448 |
3,960 |
$7.06M |
| A6021 |
Collagen dressing <=16 sq in |
24,505 |
21,173 |
$4.86M |
| A4230 |
Infus insulin pump non needl |
39,059 |
35,266 |
$4.27M |
| T4541 |
Large disposable underpad |
162,140 |
137,322 |
$4.11M |
| T4528 |
Adult size pull-on xl |
55,619 |
45,689 |
$3.99M |
| T4527 |
Adult size pull-on lg |
65,339 |
53,985 |
$3.90M |
| T4526 |
Adult size pull-on med |
62,538 |
51,891 |
$3.56M |
| A4353 |
Intermittent urinary cath |
7,828 |
6,498 |
$3.46M |
| A4385 |
Ost skn barrier sld ext wear |
77,847 |
67,350 |
$3.24M |
| A4239 |
Non-adju cgm supply allow |
31,803 |
24,816 |
$2.91M |
| A6196 |
Alginate dressing <=16 sq in |
28,987 |
24,555 |
$2.78M |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
52,883 |
46,698 |
$2.71M |
| A4351 |
Straight tip urine catheter |
24,818 |
21,587 |
$2.68M |
| T4534 |
Youth size pull-on |
36,163 |
32,963 |
$2.62M |
| A6212 |
Foam drg <=16 sq in w/border |
35,983 |
30,777 |
$2.51M |
| E0603 |
Electric breast pump |
27,756 |
24,409 |
$2.49M |
| A6210 |
Foam drg >16<=48 sq in w/o b |
16,575 |
14,064 |
$2.44M |
| T4535 |
Disposable liner/shield/pad |
86,536 |
74,807 |
$2.13M |
| A9277 |
External transmitter, cgm |
5,736 |
4,790 |
$1.99M |
| A4362 |
Solid skin barrier |
48,883 |
44,195 |
$1.95M |
| T4523 |
Adult size brief/diaper lg |
29,002 |
23,868 |
$1.92M |
| A4407 |
Ext wear ost skn barr <=4sq" |
29,755 |
25,177 |
$1.85M |
| A4409 |
Ost skn barr convex <=4 sq i |
37,790 |
32,767 |
$1.81M |
| T4522 |
Adult size brief/diaper med |
30,071 |
25,129 |
$1.65M |
| A6253 |
Absorpt drg > 48 sq in w/o b |
15,222 |
13,308 |
$1.54M |
| A6446 |
Conform band s w>=3" <5"/yd |
58,671 |
51,575 |
$1.45M |
| B4161 |
Ef ped hydrolyzed/amino acid |
3,042 |
2,648 |
$1.42M |
| A4352 |
Coude tip urinary catheter |
4,654 |
4,056 |
$1.33M |
| A4232 |
Syringe w/needle insulin 3cc |
39,242 |
35,465 |
$1.32M |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
24,132 |
21,688 |
$1.32M |
| T4524 |
Adult size brief/diaper xl |
19,027 |
15,403 |
$1.28M |
| A4425 |
Ost pch drain for barrier fl |
30,947 |
26,659 |
$1.25M |
| A5063 |
Drain ostomy pouch w/flange |
42,298 |
38,129 |
$1.15M |
| A9274 |
Ext amb insulin delivery sys |
2,364 |
2,175 |
$1.07M |
| T4530 |
Ped size brief/diaper lg |
17,565 |
15,760 |
$1.04M |
| A4927 |
Non-sterile gloves |
132,700 |
122,848 |
$1.03M |
| A4452 |
Waterproof tape |
59,638 |
53,377 |
$930K |
| A5057 |
1 pc ost pou w built-in conv |
8,620 |
7,196 |
$825K |
| A6266 |
Impreg gauze no h20/sal/yard |
9,941 |
8,824 |
$799K |
| A4554 |
Disposable underpads |
21,830 |
14,591 |
$796K |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
7,594 |
6,556 |
$753K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
5,316 |
3,990 |
$724K |
| T4525 |
Adult size pull-on sm |
10,475 |
9,104 |
$697K |
| A9278 |
External receiver, cgm sys |
2,166 |
1,812 |
$694K |
| A6449 |
Lt compres band >=3" <5"/yd |
22,852 |
19,098 |
$679K |
| A4389 |
Drainable pch w st wear barr |
9,088 |
8,174 |
$668K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
12,226 |
10,315 |
$645K |
| A6402 |
Sterile gauze <= 16 sq in |
72,730 |
64,992 |
$601K |
| A4373 |
Skin barrier with flange |
8,845 |
7,875 |
$601K |
| A5121 |
Solid skin barrier 6x6 |
9,773 |
8,415 |
$576K |
| A6199 |
Alginate drsg wound filler |
6,449 |
5,513 |
$555K |
| T4543 |
Adult disp brief/diap abv xl |
6,212 |
4,555 |
$548K |
| A6211 |
Foam drg > 48 sq in w/o brdr |
2,301 |
1,911 |
$546K |
| K0554 |
Ther cgm receiver/monitor |
4,884 |
4,306 |
$504K |
| B4150 |
Ef complet w/intact nutrient |
9,009 |
6,782 |
$503K |
| A4394 |
Ostomy pouch liq deodorant |
27,703 |
23,634 |
$472K |
| A5061 |
Pouch drainable w barrier at |
9,505 |
8,780 |
$463K |
| B4035 |
Enteral feed supp pump per d |
2,585 |
2,033 |
$448K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
12,333 |
10,904 |
$448K |
| A4419 |
Ost pch for bar w flange/flt |
9,184 |
7,688 |
$445K |
| A6010 |
Collagen based wound filler |
1,979 |
1,699 |
$425K |
| A5120 |
Skin barrier, wipe or swab |
80,980 |
73,560 |
$404K |
| A4406 |
Pectin based ostomy paste |
33,728 |
30,116 |
$391K |
| B4152 |
Ef calorie dense>/=1.5kcal |
4,435 |
3,313 |
$380K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
10,796 |
9,479 |
$314K |
| A4388 |
Drainable pch w ex wear barr |
7,373 |
6,647 |
$304K |
| A4424 |
Ost pch drain w bar & filter |
4,983 |
4,326 |
$302K |
| A4456 |
Adhesive remover, wipes |
45,784 |
40,451 |
$299K |
| A5056 |
1 pc ost pouch w filter |
5,930 |
5,023 |
$298K |
| A4390 |
Drainable pch ex wear convex |
4,201 |
3,572 |
$297K |
| A6216 |
Non-sterile gauze<=16 sq in |
38,846 |
35,634 |
$282K |
| A4432 |
Os pch urine w bar/fange/tap |
8,206 |
6,849 |
$278K |
| A4253 |
Blood glucose/reagent strips |
7,230 |
6,068 |
$273K |
| T4533 |
Youth size brief/diaper |
3,471 |
3,358 |
$265K |
| T4537 |
Reusable underpad bed size |
14,360 |
13,487 |
$262K |
| A5054 |
Clsd ostomy pouch w/flange |
6,100 |
5,516 |
$254K |
| T4521 |
Adult size brief/diaper sm |
3,994 |
3,465 |
$240K |
| A6248 |
Hydrogel drsg gel filler |
5,050 |
4,536 |
$237K |
| A4450 |
Non-waterproof tape |
51,995 |
47,638 |
$232K |
| B4154 |
Ef spec metabolic noninherit |
2,886 |
2,108 |
$221K |
| A4357 |
Bedside drainage bag |
28,380 |
25,363 |
$220K |
| A6452 |
High compres band w>=3"<5"yd |
2,508 |
2,067 |
$202K |
| A6545 |
Grad com non-elastic bk surg |
4,692 |
3,115 |
$197K |
| A6022 |
Collagen drsg>16<=48 sq in |
1,145 |
966 |
$195K |
| A4670 |
Automatic bp monitor, dial |
4,335 |
4,222 |
$180K |
| A4371 |
Skin barrier powder per oz |
39,396 |
35,831 |
$170K |
| A6443 |
Conform band n/s w>=3"<5"/yd |
10,968 |
9,784 |
$170K |
| A6219 |
Gauze <= 16 sq in w/border |
9,695 |
8,673 |
$164K |
| T4532 |
Ped size pull-on lg |
2,463 |
2,283 |
$157K |
| A4216 |
Sterile water/saline, 10 ml |
12,476 |
11,803 |
$150K |
| A4430 |
Ost urine pch w b/bltin conv |
2,287 |
1,965 |
$142K |
| B9998 |
Enteral supp not otherwise c |
2,733 |
1,938 |
$141K |
| A4224 |
Supply insulin inf cath/wk |
7,485 |
6,241 |
$141K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
3,413 |
3,020 |
$131K |
| A6454 |
Self-adher band w>=3" <5"/yd |
6,870 |
5,725 |
$130K |
| A6258 |
Transparent film >16<=48 in |
4,040 |
3,588 |
$130K |
| A4410 |
Ost skn barr extnd >4 sq |
2,204 |
1,881 |
$129K |
| A4310 |
Insert tray w/o bag/cath |
9,370 |
8,361 |
$128K |
| E2103 |
Non-adju cgm receiver/mon |
1,863 |
1,389 |
$127K |
| A4231 |
Infusion insulin pump needle |
1,350 |
1,186 |
$126K |
| A4416 |
Ost pch clsd w barrier/filtr |
1,684 |
1,482 |
$122K |
| A4392 |
Urinary pouch w st wear barr |
1,764 |
1,618 |
$122K |
| A4349 |
Disposable male external cat |
4,461 |
3,950 |
$120K |
| A4221 |
Supp non-insulin inf cath/wk |
2,443 |
2,359 |
$119K |
| A4427 |
Ost pch drain/barr lk flng/f |
4,433 |
3,773 |
$117K |
| A6240 |
Hydrocolld drg filler paste |
2,162 |
2,017 |
$116K |
| A6450 |
Lt compres band >=5"/yd |
5,165 |
4,265 |
$115K |
| A4393 |
Urine pch w ex wear bar conv |
2,036 |
1,817 |
$110K |
| A4217 |
Sterile water/saline, 500 ml |
16,578 |
15,581 |
$107K |
| A6220 |
Gauze >16 <=48 sq in w/bordr |
2,340 |
2,072 |
$106K |
| A6207 |
Contact layer >16<= 48 sq in |
3,127 |
2,642 |
$104K |
| A4358 |
Urinary leg or abdomen bag |
12,797 |
11,404 |
$99K |
| A4367 |
Ostomy belt |
23,708 |
21,410 |
$97K |
| A5073 |
Urinary pouch on barr w/flng |
3,100 |
2,801 |
$88K |
| B4088 |
Gastro/jejuno tube, low-pro |
1,900 |
1,628 |
$87K |
| A6250 |
Skin seal protect moisturizr |
6,872 |
5,544 |
$84K |
| B4036 |
Enteral feed sup kit grav by |
1,904 |
1,725 |
$73K |
| A4225 |
Sup/ext insulin inf pump syr |
7,668 |
6,491 |
$73K |
| A6217 |
Non-sterile gauze>16<=48 sq |
6,238 |
5,601 |
$68K |
| A4344 |
Cath indw foley 2 way silicn |
3,525 |
2,935 |
$65K |
| A4930 |
Sterile, gloves per pair |
2,816 |
2,492 |
$62K |
| A4411 |
Ost skn barr extnd =4sq |
1,886 |
1,537 |
$62K |
| A4520 |
Incontinence garment anytype |
2,467 |
2,123 |
$60K |
| A4408 |
Ext wear ost skn barr >4sq" |
855 |
663 |
$59K |
| A6457 |
Tubular dressing |
5,494 |
4,762 |
$56K |
| A4322 |
Irrigation syringe |
4,550 |
4,068 |
$55K |
| A4413 |
2 pc drainable ost pouch |
1,077 |
938 |
$54K |
| A4338 |
Indwelling catheter latex |
7,442 |
6,712 |
$53K |
| K0552 |
Sup/ext non-ins inf pump syr |
2,597 |
2,502 |
$51K |
| A4428 |
Urine ost pouch w faucet/tap |
796 |
646 |
$51K |
| A4396 |
Peristomal hernia supprt blt |
2,470 |
2,170 |
$50K |
| A4320 |
Irrigation tray |
2,844 |
2,534 |
$50K |
| B4034 |
Enter feed supkit syr by day |
520 |
436 |
$41K |
| A4369 |
Skin barrier liquid per oz |
11,029 |
9,807 |
$40K |
| A6261 |
Wound filler gel/paste /oz |
1,154 |
1,037 |
$38K |
| A4455 |
Adhesive remover per ounce |
9,705 |
8,860 |
$37K |
| A4402 |
Lubricant per ounce |
9,481 |
8,655 |
$36K |
| A4423 |
Ost pch for bar w lk fl/fltr |
883 |
757 |
$35K |
| A6456 |
Zinc paste band w >=3"<5"/yd |
1,706 |
1,393 |
$33K |
| A6203 |
Composite drsg <= 16 sq in |
1,130 |
947 |
$32K |
| A6445 |
Conform band s w <3"/yd |
1,898 |
1,718 |
$32K |
| A6257 |
Transparent film <= 16 sq in |
1,689 |
1,526 |
$31K |
| A4415 |
Ost skn barr w/o conv >4 sqi |
580 |
527 |
$29K |
| A6235 |
Hydrocolld drg >16<=48 w/o b |
266 |
228 |
$29K |
| A4335 |
Incontinence supply |
6,908 |
4,396 |
$29K |
| A6441 |
Pad band w>=3" <5"/yd |
2,534 |
2,194 |
$27K |
| A4259 |
Lancets per box |
4,559 |
3,929 |
$27K |
| A6251 |
Absorpt drg <=16 sq in w/o b |
1,770 |
1,632 |
$27K |
| A6243 |
Hydrogel drg >16<=48 w/o bdr |
135 |
115 |
$26K |
| A4412 |
Ost pouch drain high output |
1,227 |
999 |
$26K |
| A6447 |
Conform band s w >=5"/yd |
471 |
422 |
$23K |
| A6218 |
Non-sterile gauze > 48 sq in |
1,757 |
1,635 |
$23K |
| A4247 |
Betadine/iodine swabs/wipes |
2,013 |
1,831 |
$22K |
| A4314 |
Cath w/drainage 2-way latex |
1,886 |
1,747 |
$22K |
| A6242 |
Hydrogel drg <=16 in w/o bdr |
277 |
242 |
$21K |
| A6407 |
Packing strips, non-impreg |
795 |
690 |
$21K |
| A4332 |
Lube sterile packet |
2,765 |
2,329 |
$19K |
| A4333 |
Urinary cath anchor device |
3,059 |
2,723 |
$18K |
| A4405 |
Nonpectin based ostomy paste |
2,135 |
1,933 |
$16K |
| A5055 |
Stoma cap |
619 |
573 |
$15K |
| A4340 |
Indwelling catheter special |
520 |
457 |
$15K |
| A6403 |
Sterile gauze>16 <= 48 sq in |
811 |
752 |
$15K |
| A6530 |
Compression stocking bk18-30 |
403 |
346 |
$13K |
| A6442 |
Conform band n/s w<3"/yd |
1,804 |
1,564 |
$13K |
| A4649 |
Surgical supplies |
1,341 |
910 |
$13K |
| A4364 |
Adhesive, liquid or equal |
2,197 |
1,915 |
$12K |
| A4326 |
Male external catheter |
83 |
66 |
$12K |
| A4391 |
Urinary pouch w ex wear barr |
223 |
205 |
$12K |
| B4100 |
Food thickener oral |
240 |
214 |
$11K |
| A6254 |
Absorpt drg <=16 sq in w/bdr |
687 |
629 |
$10K |
| A6260 |
Wound cleanser any type/size |
2,258 |
2,073 |
$9K |
| A6531 |
Compress stking bk30-40 surg |
277 |
210 |
$9K |
| A9270 |
Non-covered item or service |
5,331 |
3,723 |
$9K |
| A4354 |
Cath insertion tray w/bag |
236 |
98 |
$9K |
| A4433 |
Urine ost pch bar w lock fln |
323 |
234 |
$8K |
| A5071 |
Urinary pouch w/barrier |
129 |
115 |
$8K |
| A6204 |
Composite drsg >16<=48 sq in |
143 |
108 |
$8K |
| A6448 |
Lt compres band <3"/yd |
364 |
295 |
$7K |
| A4334 |
Urinary cath leg strap |
2,442 |
2,166 |
$7K |
| A4331 |
Extension drainage tubing |
3,092 |
2,691 |
$6K |
| A6453 |
Self-adher band w <3"/yd |
304 |
254 |
$6K |
| A4215 |
Sterile needle |
215 |
206 |
$5K |
| A4245 |
Alcohol wipes per box |
2,710 |
2,537 |
$5K |
| A5052 |
Clsd ostomy pouch w/o barr |
114 |
106 |
$5K |
| A5102 |
Bedside drain btl w/wo tube |
401 |
355 |
$5K |
| A4311 |
Catheter w/o bag 2-way latex |
605 |
565 |
$4K |
| A4404 |
Ostomy ring each |
216 |
208 |
$4K |
| E0445 |
Oximeter non-invasive |
70 |
66 |
$4K |
| E1399 |
Durable medical equipment mi |
147 |
120 |
$4K |
| A6259 |
Transparent film > 48 sq in |
46 |
37 |
$3K |
| E0240 |
Bath/shower chair |
100 |
93 |
$3K |
| T4540 |
Reusable underpad chair size |
66 |
65 |
$3K |
| ZZZZZ |
|
57 |
42 |
$3K |
| A5131 |
Appliance cleaner |
535 |
460 |
$3K |
| E0143 |
Walker folding wheeled w/o s |
150 |
121 |
$2K |
| B4155 |
Ef incomplete/modular |
45 |
37 |
$2K |
| A4246 |
Betadine/phisohex solution |
103 |
102 |
$2K |
| A6224 |
Gauze > 48 in no w/sal w/o b |
31 |
25 |
$2K |
| A4315 |
Cath w/drainage 2-way silcne |
90 |
89 |
$2K |
| A4363 |
Ostomy clamp, replacement |
719 |
621 |
$1K |
| A4629 |
Tracheostomy care kit |
14 |
12 |
$1K |
| A4421 |
Ostomy supply misc |
278 |
207 |
$853.96 |
| A5081 |
Stoma plug or seal, any type |
15 |
12 |
$427.12 |
| A5200 |
Percutaneous catheter anchor |
16 |
12 |
$413.78 |
| A6444 |
Conform band n/s w>=5"/yd |
19 |
13 |
$395.51 |
| A6455 |
Self-adher band >=5"/yd |
13 |
12 |
$348.57 |
| A7526 |
Tracheostomy tube collar |
13 |
12 |
$348.27 |
| A4426 |
Ost pch drain 2 piece system |
13 |
13 |
$323.33 |
| A4366 |
Ostomy vent |
25 |
25 |
$205.99 |
| E0247 |
Trans bench w/wo comm open |
20 |
13 |
$77.26 |