| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
7,060 |
5,832 |
$211K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,763 |
1,510 |
$177K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,586 |
1,279 |
$141K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,594 |
1,305 |
$134K |
| A4927 |
Gloves, non-sterile, per 100 |
9,499 |
7,861 |
$116K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,888 |
1,598 |
$71K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
576 |
488 |
$59K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
448 |
326 |
$42K |
| 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 |
386 |
328 |
$21K |
| 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 |
87 |
68 |
$10K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
91 |
74 |
$9K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
375 |
307 |
$7K |
| A4452 |
Tape, waterproof, per 18 square inches |
269 |
207 |
$6K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
799 |
664 |
$5K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
49 |
43 |
$4K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
42 |
31 |
$4K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
46 |
37 |
$3K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
348 |
292 |
$2K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
430 |
375 |
$2K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
327 |
263 |
$2K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
277 |
234 |
$2K |
| A4217 |
Sterile water/saline, 500 ml |
453 |
371 |
$1K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
28 |
25 |
$1K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
89 |
72 |
$1K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
12 |
12 |
$1K |
| K0001 |
Standard wheelchair |
33 |
24 |
$895.24 |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
14 |
13 |
$483.29 |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
134 |
116 |
$479.94 |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
30 |
25 |
$280.10 |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
77 |
66 |
$272.00 |
| A4402 |
Lubricant, per ounce |
17 |
14 |
$32.76 |