| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
268,801 |
255,026 |
$16.19M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
79,422 |
76,450 |
$8.25M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
71,144 |
68,187 |
$7.48M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
171,422 |
164,131 |
$7.16M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
49,819 |
47,932 |
$6.35M |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
23,636 |
20,589 |
$5.85M |
| B4161 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
7,816 |
6,828 |
$5.20M |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
6,038 |
5,326 |
$4.68M |
| 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 |
17,603 |
15,204 |
$4.32M |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
20,972 |
20,023 |
$4.02M |
| A4927 |
Gloves, non-sterile, per 100 |
200,826 |
189,933 |
$2.45M |
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
20,179 |
16,236 |
$2.44M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
28,236 |
26,472 |
$2.37M |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
19,665 |
18,706 |
$2.31M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
23,112 |
21,814 |
$2.05M |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
23,524 |
22,108 |
$2.02M |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 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 |
12,509 |
10,340 |
$2.01M |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
17,550 |
16,061 |
$1.70M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
19,483 |
18,024 |
$1.44M |
| B4149 |
Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
3,567 |
3,001 |
$1.14M |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
4,272 |
3,467 |
$1.03M |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
6,802 |
6,082 |
$981K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
4,180 |
3,989 |
$833K |
| 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 |
2,737 |
2,453 |
$814K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
6,807 |
6,060 |
$713K |
| B9002 |
Enteral nutrition infusion pump, any type |
1,429 |
1,264 |
$567K |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
789 |
703 |
$565K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
7,108 |
6,584 |
$489K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
4,135 |
3,593 |
$482K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
5,978 |
5,660 |
$436K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
3,761 |
3,459 |
$277K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
3,116 |
2,757 |
$267K |
| B4036 |
Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
1,762 |
1,545 |
$257K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
5,060 |
4,692 |
$251K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
3,818 |
3,589 |
$193K |
| 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 |
1,006 |
907 |
$175K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
3,980 |
3,573 |
$173K |
| A6213 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
2,072 |
1,843 |
$155K |
| B9998 |
Noc for enteral supplies |
3,215 |
2,676 |
$151K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
3,168 |
2,715 |
$147K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
10,179 |
9,052 |
$146K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
1,865 |
1,691 |
$127K |
| 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 |
4,402 |
3,931 |
$122K |
| A6211 |
Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
239 |
206 |
$120K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
3,558 |
3,171 |
$116K |
| A4452 |
Tape, waterproof, per 18 square inches |
5,026 |
4,503 |
$106K |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
1,376 |
1,252 |
$104K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,565 |
1,371 |
$97K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
8,225 |
7,466 |
$96K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
2,871 |
2,646 |
$93K |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
608 |
563 |
$89K |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
1,182 |
1,097 |
$85K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
1,235 |
1,150 |
$84K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
2,581 |
2,341 |
$83K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
1,027 |
930 |
$61K |
| A4456 |
Adhesive remover, wipes, any type, each |
7,537 |
7,012 |
$60K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
853 |
812 |
$59K |
| A4388 |
Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each |
1,724 |
1,609 |
$55K |
| A5120 |
Skin barrier, wipes or swabs, each |
7,398 |
6,933 |
$53K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
3,812 |
3,532 |
$53K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
5,510 |
4,968 |
$47K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
243 |
227 |
$45K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
3,060 |
2,763 |
$40K |
| E0776 |
Iv pole |
684 |
611 |
$39K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
796 |
739 |
$36K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
3,068 |
2,603 |
$34K |
| A4402 |
Lubricant, per ounce |
7,250 |
6,490 |
$31K |
| B4155 |
Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit |
634 |
532 |
$27K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
4,477 |
3,981 |
$25K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
2,841 |
2,503 |
$21K |
| A4371 |
Ostomy skin barrier, powder, per oz |
5,190 |
4,879 |
$20K |
| 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 |
349 |
325 |
$17K |
| B4082 |
Nasogastric tubing without stylet |
1,474 |
1,272 |
$14K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
391 |
372 |
$14K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
2,410 |
2,143 |
$13K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
1,603 |
1,516 |
$12K |
| B4158 |
Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit |
122 |
108 |
$11K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
214 |
195 |
$8K |
| A4367 |
Ostomy belt, each |
1,504 |
1,409 |
$7K |
| A4322 |
Irrigation syringe, bulb or piston, each |
748 |
635 |
$6K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
140 |
130 |
$5K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
465 |
448 |
$5K |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
288 |
273 |
$4K |
| A4657 |
Syringe, with or without needle, each |
1,990 |
1,769 |
$3K |
| A4390 |
Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each |
26 |
24 |
$2K |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
438 |
424 |
$2K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
15 |
14 |
$840.86 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
205 |
168 |
$672.87 |
| B4081 |
Nasogastric tubing with stylet |
38 |
24 |
$443.78 |
| A4311 |
Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
40 |
36 |
$399.34 |
| A6260 |
Wound cleansers, any type, any size |
66 |
53 |
$157.75 |
| A6450 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard |
28 |
28 |
$127.32 |