| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
3,833 |
3,328 |
$596K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
4,165 |
3,669 |
$289K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
5,311 |
4,479 |
$231K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
3,343 |
2,904 |
$222K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
2,182 |
1,924 |
$200K |
| 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 |
4,768 |
4,233 |
$158K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
8,634 |
7,331 |
$122K |
| 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 |
894 |
570 |
$111K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
9,307 |
8,246 |
$81K |
| A4452 |
Tape, waterproof, per 18 square inches |
6,346 |
5,534 |
$64K |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
2,257 |
1,987 |
$48K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
7,835 |
6,836 |
$39K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
7,102 |
6,227 |
$33K |
| A6199 |
Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches |
568 |
505 |
$27K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
620 |
529 |
$26K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,429 |
1,249 |
$26K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
1,549 |
1,350 |
$21K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
491 |
436 |
$21K |
| A4927 |
Gloves, non-sterile, per 100 |
3,323 |
2,956 |
$19K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
361 |
271 |
$18K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
855 |
776 |
$17K |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
1,922 |
1,655 |
$15K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
345 |
309 |
$15K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
2,404 |
2,226 |
$12K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
596 |
549 |
$12K |
| A6452 |
High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard |
252 |
211 |
$12K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
446 |
395 |
$12K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
732 |
685 |
$11K |
| T4541 |
Incontinence product, disposable underpad, large, each |
352 |
322 |
$7K |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
1,297 |
1,069 |
$7K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
2,560 |
2,292 |
$6K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
1,382 |
1,291 |
$5K |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
93 |
86 |
$5K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
1,765 |
1,624 |
$4K |
| A6450 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard |
332 |
281 |
$4K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
1,097 |
1,014 |
$4K |
| A5120 |
Skin barrier, wipes or swabs, each |
1,502 |
1,376 |
$4K |
| A6445 |
Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard |
206 |
193 |
$2K |
| A6203 |
Composite dressing, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
121 |
110 |
$2K |
| A6240 |
Hydrocolloid dressing, wound filler, paste, sterile, per ounce |
202 |
185 |
$2K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
418 |
384 |
$2K |
| A6207 |
Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
32 |
13 |
$2K |
| A6456 |
Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
110 |
91 |
$1K |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
922 |
861 |
$1K |
| A4371 |
Ostomy skin barrier, powder, per oz |
629 |
575 |
$1K |
| A6022 |
Collagen dressing, sterile, size more than 16 sq. in. but less than or equal to 48 sq. in., each |
13 |
13 |
$859.84 |
| A4456 |
Adhesive remover, wipes, any type, each |
484 |
459 |
$763.29 |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
559 |
515 |
$591.97 |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
65 |
58 |
$398.09 |
| A6441 |
Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard |
124 |
105 |
$394.81 |
| A4315 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone |
15 |
12 |
$235.78 |
| A4367 |
Ostomy belt, each |
27 |
25 |
$104.16 |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
14 |
13 |
$87.04 |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
65 |
58 |
$81.57 |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
12 |
12 |
$23.80 |