| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
4,647 |
4,625 |
$460K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,291 |
2,273 |
$256K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
393 |
393 |
$252K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
909 |
906 |
$208K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
966 |
964 |
$180K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,039 |
1,035 |
$143K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
758 |
756 |
$142K |
| A4335 |
Incontinence supply; miscellaneous |
3,759 |
3,683 |
$141K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
874 |
870 |
$129K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
545 |
541 |
$94K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
742 |
740 |
$67K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,209 |
1,201 |
$61K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
507 |
506 |
$50K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
1,862 |
1,851 |
$47K |
| A4452 |
Tape, waterproof, per 18 square inches |
877 |
874 |
$40K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
356 |
356 |
$38K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
198 |
195 |
$38K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
291 |
291 |
$36K |
| A4927 |
Gloves, non-sterile, per 100 |
1,997 |
1,989 |
$35K |
| 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 |
74 |
74 |
$31K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
286 |
285 |
$28K |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
224 |
224 |
$24K |
| A6456 |
Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
118 |
117 |
$23K |
| A6545 |
Gradient compression wrap, non-elastic, below knee, 30-50 mmhg, used as a surgical dressing, each |
88 |
87 |
$21K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
306 |
302 |
$20K |
| 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 |
381 |
380 |
$18K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
80 |
80 |
$13K |
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
29 |
29 |
$13K |
| A4217 |
Sterile water/saline, 500 ml |
943 |
941 |
$10K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
25 |
25 |
$9K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
38 |
38 |
$9K |
| E0144 |
Walker, enclosed, four sided framed, rigid or folding, wheeled with posterior seat |
33 |
33 |
$8K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
96 |
96 |
$7K |
| L1833 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
12 |
12 |
$7K |
| A6260 |
Wound cleansers, any type, any size |
464 |
462 |
$6K |
| A5120 |
Skin barrier, wipes or swabs, each |
104 |
104 |
$5K |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
132 |
132 |
$4K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
14 |
14 |
$3K |
| K0554 |
Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system |
14 |
14 |
$3K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
45 |
44 |
$3K |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
27 |
27 |
$2K |
| A4248 |
Chlorhexidine containing antiseptic, 1 ml |
50 |
50 |
$2K |
| L2810 |
Addition to lower extremity orthosis, knee control, condylar pad |
13 |
13 |
$2K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
12 |
12 |
$1K |
| E0240 |
Bath/shower chair, with or without wheels, any size |
13 |
13 |
$1K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
27 |
27 |
$1K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
13 |
13 |
$769.13 |
| 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 |
16 |
12 |
$453.60 |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
12 |
12 |
$396.20 |