| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
7,621 |
7,002 |
$1.01M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
2,647 |
2,456 |
$384K |
| A4554 |
Disposable underpads, all sizes |
6,127 |
5,755 |
$343K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
1,898 |
1,778 |
$304K |
| A4245 |
Alcohol wipes, per box |
9,423 |
8,635 |
$265K |
| A4772 |
Blood glucose test strips, for dialysis, per 50 |
2,193 |
2,071 |
$197K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,858 |
1,714 |
$183K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
1,304 |
1,266 |
$132K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
1,079 |
1,055 |
$104K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
861 |
825 |
$99K |
| A4927 |
Gloves, non-sterile, per 100 |
5,597 |
5,200 |
$79K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
996 |
944 |
$74K |
| A6221 |
Gauze, non-impregnated, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing |
519 |
481 |
$37K |
| A4215 |
Needle, sterile, any size, each |
1,736 |
1,650 |
$10K |
| A4670 |
Automatic blood pressure monitor |
82 |
80 |
$8K |
| E2101 |
Blood glucose monitor with integrated lancing/blood sample |
26 |
25 |
$3K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
27 |
25 |
$2K |
| S5199 |
Personal care item, nos, each |
25 |
24 |
$1K |
| A4259 |
Lancets, per box of 100 |
50 |
48 |
$224.26 |
| 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 |
293 |
284 |
$0.00 |
| A4335 |
Incontinence supply; miscellaneous |
1,741 |
1,692 |
$0.00 |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
13 |
12 |
$0.00 |