| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A9276 |
Disposable sensor, cgm sys |
54,922 |
49,427 |
$16.26M |
| K0553 |
Ther cgm supply allowance |
72,894 |
63,652 |
$11.48M |
| A4239 |
Non-adju cgm supply allow |
41,849 |
38,392 |
$6.53M |
| A9277 |
External transmitter, cgm |
10,024 |
9,240 |
$5.28M |
| A4230 |
Infus insulin pump non needl |
28,066 |
25,406 |
$4.75M |
| A9274 |
Ext amb insulin delivery sys |
6,585 |
5,489 |
$4.03M |
| E0784 |
Ext amb infusn pump insulin |
1,325 |
1,006 |
$3.37M |
| A9278 |
External receiver, cgm sys |
3,322 |
2,899 |
$1.18M |
| A9999 |
Dme supply or accessory, nos |
5,692 |
4,573 |
$790K |
| K0554 |
Ther cgm receiver/monitor |
4,522 |
3,953 |
$616K |
| A4554 |
Disposable underpads |
10,334 |
9,661 |
$577K |
| A4232 |
Syringe w/needle insulin 3cc |
11,450 |
10,723 |
$552K |
| A4225 |
Sup/ext insulin inf pump syr |
15,670 |
13,512 |
$431K |
| T4523 |
Adult size brief/diaper lg |
3,909 |
3,656 |
$413K |
| A7048 |
Vacuum drain bottle/tube kit |
1,793 |
609 |
$392K |
| T4522 |
Adult size brief/diaper med |
4,672 |
4,422 |
$379K |
| A4351 |
Straight tip urine catheter |
2,440 |
2,254 |
$301K |
| T4524 |
Adult size brief/diaper xl |
2,396 |
2,275 |
$263K |
| A4253 |
Blood glucose/reagent strips |
6,728 |
5,752 |
$239K |
| E0603 |
Electric breast pump |
1,541 |
1,454 |
$224K |
| E2103 |
Non-adju cgm receiver/mon |
1,725 |
1,497 |
$206K |
| A4231 |
Infusion insulin pump needle |
1,587 |
1,341 |
$179K |
| T4535 |
Disposable liner/shield/pad |
3,967 |
3,608 |
$125K |
| A6257 |
Transparent film <= 16 sq in |
4,275 |
3,692 |
$86K |
| T4537 |
Reusable underpad bed size |
2,749 |
2,471 |
$81K |
| A4385 |
Ost skn barrier sld ext wear |
1,371 |
1,199 |
$60K |
| T4530 |
Ped size brief/diaper lg |
918 |
860 |
$57K |
| T4533 |
Youth size brief/diaper |
760 |
728 |
$54K |
| A4224 |
Supply insulin inf cath/wk |
1,339 |
862 |
$49K |
| A4409 |
Ost skn barr convex <=4 sq i |
850 |
672 |
$46K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
809 |
710 |
$40K |
| A4425 |
Ost pch drain for barrier fl |
838 |
727 |
$38K |
| A4927 |
Non-sterile gloves |
9,000 |
8,102 |
$37K |
| T4521 |
Adult size brief/diaper sm |
467 |
433 |
$35K |
| K0552 |
Sup/ext non-ins inf pump syr |
1,009 |
703 |
$27K |
| A6258 |
Transparent film >16<=48 in |
606 |
534 |
$26K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
576 |
525 |
$26K |
| A4456 |
Adhesive remover, wipes |
2,905 |
2,457 |
$23K |
| A4407 |
Ext wear ost skn barr <=4sq" |
277 |
229 |
$22K |
| A5063 |
Drain ostomy pouch w/flange |
548 |
441 |
$22K |
| A5120 |
Skin barrier, wipe or swab |
2,779 |
2,418 |
$22K |
| A6402 |
Sterile gauze <= 16 sq in |
2,135 |
1,980 |
$21K |
| A4357 |
Bedside drainage bag |
2,040 |
1,691 |
$20K |
| A4238 |
Adju cgm supply allowance |
57 |
52 |
$18K |
| 99503 |
|
105 |
94 |
$18K |
| A4259 |
Lancets per box |
3,086 |
2,699 |
$16K |
| A4670 |
Automatic bp monitor, dial |
201 |
183 |
$10K |
| E0607 |
Blood glucose monitor home |
367 |
328 |
$9K |
| A4358 |
Urinary leg or abdomen bag |
1,104 |
941 |
$8K |
| A4364 |
Adhesive, liquid or equal |
832 |
721 |
$7K |
| A4402 |
Lubricant per ounce |
1,819 |
1,662 |
$6K |
| A4450 |
Non-waterproof tape |
1,186 |
1,091 |
$6K |
| A4245 |
Alcohol wipes per box |
2,180 |
1,910 |
$5K |
| A4217 |
Sterile water/saline, 500 ml |
716 |
639 |
$5K |
| A6446 |
Conform band s w>=3" <5"/yd |
429 |
384 |
$5K |
| A4394 |
Ostomy pouch liq deodorant |
345 |
281 |
$5K |
| A4353 |
Intermittent urinary cath |
18 |
14 |
$4K |
| T4526 |
Adult size pull-on med |
51 |
36 |
$4K |
| A4362 |
Solid skin barrier |
68 |
64 |
$3K |
| A4406 |
Pectin based ostomy paste |
204 |
142 |
$3K |
| A6197 |
Alginate drsg >16 <=48 sq in |
28 |
24 |
$3K |
| A4452 |
Waterproof tape |
429 |
367 |
$3K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
19 |
13 |
$3K |
| A4432 |
Os pch urine w bar/fange/tap |
79 |
51 |
$2K |
| A4371 |
Skin barrier powder per oz |
183 |
150 |
$2K |
| A4216 |
Sterile water/saline, 10 ml |
159 |
137 |
$2K |
| A6216 |
Non-sterile gauze<=16 sq in |
486 |
438 |
$2K |
| A6212 |
Foam drg <=16 sq in w/border |
33 |
27 |
$1K |
| A4344 |
Cath indw foley 2 way silicn |
67 |
50 |
$1K |
| T4541 |
Large disposable underpad |
31 |
24 |
$1K |
| A4349 |
Disposable male external cat |
43 |
40 |
$982.18 |
| A4310 |
Insert tray w/o bag/cath |
67 |
42 |
$215.88 |
| A4320 |
Irrigation tray |
12 |
12 |
$195.71 |
| A4338 |
Indwelling catheter latex |
44 |
29 |
$194.26 |
| A6443 |
Conform band n/s w>=3"<5"/yd |
12 |
12 |
$66.27 |
| A4258 |
Lancet device each |
16 |
16 |
$64.62 |
| 99080 |
|
2,129 |
1,608 |
$0.00 |