| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
32,342 |
31,154 |
$8.53M |
| A4554 |
Disposable underpads, all sizes |
44,381 |
42,737 |
$3.33M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
21,071 |
20,455 |
$3.08M |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
12,066 |
11,728 |
$1.90M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
16,217 |
15,702 |
$1.70M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
16,628 |
16,244 |
$1.42M |
| A6260 |
Wound cleansers, any type, any size |
24,670 |
24,262 |
$1.31M |
| A4927 |
Gloves, non-sterile, per 100 |
50,127 |
48,527 |
$1.21M |
| A4670 |
Automatic blood pressure monitor |
10,551 |
10,196 |
$1.00M |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
6,981 |
6,714 |
$957K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
3,080 |
2,982 |
$655K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
3,214 |
3,085 |
$499K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
3,994 |
3,887 |
$443K |
| E0570 |
Nebulizer, with compressor |
4,983 |
4,787 |
$423K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
2,842 |
2,777 |
$419K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
3,924 |
3,761 |
$405K |
| A5120 |
Skin barrier, wipes or swabs, each |
17,245 |
16,907 |
$404K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
1,688 |
1,489 |
$351K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
3,342 |
3,206 |
$306K |
| S5199 |
Personal care item, nos, each |
9,365 |
9,189 |
$291K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
2,756 |
2,684 |
$283K |
| E0245 |
Tub stool or bench |
2,967 |
2,832 |
$244K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
1,138 |
1,086 |
$232K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
8,550 |
8,069 |
$200K |
| E0246 |
Transfer tub rail attachment |
540 |
528 |
$183K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
2,437 |
2,331 |
$166K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
1,529 |
1,432 |
$165K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
3,372 |
3,241 |
$146K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
1,754 |
1,660 |
$127K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
2,506 |
2,408 |
$122K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
1,059 |
1,019 |
$120K |
| A4928 |
Surgical mask, per 20 |
6,633 |
6,530 |
$116K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
2,451 |
2,343 |
$104K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
4,555 |
4,310 |
$94K |
| A6539 |
Gradient compression stocking, waist length, 18-30 mmhg, each |
481 |
470 |
$91K |
| K0001 |
Standard wheelchair |
4,997 |
4,688 |
$90K |
| A4217 |
Sterile water/saline, 500 ml |
3,749 |
3,588 |
$89K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
2,250 |
2,156 |
$87K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
1,734 |
1,264 |
$79K |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
1,971 |
1,851 |
$79K |
| 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 |
198 |
186 |
$76K |
| 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 |
213 |
202 |
$72K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
395 |
380 |
$71K |
| L8000 |
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
1,352 |
1,289 |
$69K |
| E0243 |
Toilet rail, each |
1,358 |
1,019 |
$67K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
1,349 |
1,263 |
$64K |
| 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 |
1,039 |
983 |
$60K |
| A6214 |
Foam dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing |
290 |
277 |
$54K |
| A4452 |
Tape, waterproof, per 18 square inches |
1,140 |
1,096 |
$45K |
| L1812 |
Knee orthosis, elastic with joints, prefabricated, off-the-shelf |
526 |
420 |
$41K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
1,196 |
1,131 |
$40K |
| E0241 |
Bath tub wall rail, each |
906 |
872 |
$38K |
| E0244 |
Raised toilet seat |
828 |
805 |
$33K |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
614 |
586 |
$29K |
| 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 |
473 |
454 |
$29K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
393 |
228 |
$28K |
| E0149 |
Walker, heavy duty, wheeled, rigid or folding, any type |
1,202 |
1,125 |
$28K |
| E0156 |
Seat attachment, walker |
2,289 |
2,183 |
$27K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
225 |
221 |
$25K |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
945 |
910 |
$24K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
2,063 |
1,943 |
$23K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
669 |
629 |
$23K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
395 |
227 |
$23K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
2,137 |
2,015 |
$20K |
| 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 |
300 |
271 |
$20K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
1,492 |
1,423 |
$20K |
| E0303 |
Hospital bed, heavy duty, extra wide, with weight capacity greater than 350 pounds, but less than or equal to 600 pounds, with any type side rails, with mattress |
137 |
133 |
$19K |
| A4245 |
Alcohol wipes, per box |
2,690 |
2,486 |
$17K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
2,000 |
1,935 |
$15K |
| A4402 |
Lubricant, per ounce |
2,425 |
2,332 |
$15K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
82 |
82 |
$14K |
| A4456 |
Adhesive remover, wipes, any type, each |
1,369 |
1,322 |
$13K |
| K0004 |
High strength, lightweight wheelchair |
271 |
262 |
$12K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
12 |
12 |
$12K |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
702 |
677 |
$10K |
| K0007 |
Extra heavy duty wheelchair |
108 |
105 |
$10K |
| A4408 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, with built-in convexity, larger than 4 x 4 inches, each |
52 |
52 |
$10K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
634 |
587 |
$10K |
| A6211 |
Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
12 |
12 |
$8K |
| E0604 |
Breast pump, hospital grade, electric (ac and / or dc), any type |
115 |
99 |
$7K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
461 |
447 |
$7K |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
50 |
50 |
$6K |
| L8030 |
Breast prosthesis, silicone or equal, without integral adhesive |
33 |
30 |
$5K |
| L0625 |
Lumbar orthosis, flexible, provides lumbar support, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include pendulous abdomen design, shoulder straps, stays, prefabricated, off-the-shelf |
126 |
125 |
$5K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
41 |
40 |
$5K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
449 |
428 |
$4K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
85 |
84 |
$4K |
| A4931 |
Oral thermometer, reusable, any type, each |
375 |
370 |
$3K |
| A7015 |
Aerosol mask, used with dme nebulizer |
2,643 |
2,571 |
$3K |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
2,005 |
1,965 |
$3K |
| A6207 |
Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
38 |
37 |
$3K |
| E1038 |
Transport chair, adult size, patient weight capacity up to and including 300 pounds |
248 |
235 |
$3K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
79 |
77 |
$3K |
| A4246 |
Betadine or phisohex solution, per pint |
94 |
85 |
$2K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
12 |
12 |
$2K |
| E0105 |
Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips |
57 |
55 |
$2K |
| E0210 |
Electric heat pad, standard |
81 |
73 |
$2K |
| A6531 |
Gradient compression stocking, below knee, 30-40 mmhg, used as a surgical dressing, each |
12 |
12 |
$2K |
| A6441 |
Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard |
150 |
148 |
$2K |
| A4371 |
Ostomy skin barrier, powder, per oz |
260 |
252 |
$2K |
| A5054 |
Ostomy pouch, closed; for use on barrier with flange (2 piece), each |
45 |
37 |
$1K |
| E0602 |
Breast pump, manual, any type |
53 |
52 |
$1K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,502 |
1,498 |
$1K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
50 |
50 |
$1K |
| B4088 |
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each |
19 |
14 |
$1K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
27 |
24 |
$1K |
| L0650 |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
49 |
46 |
$983.39 |
| A4415 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 inches, each |
12 |
12 |
$870.64 |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
164 |
146 |
$784.00 |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
40 |
39 |
$774.41 |
| A4364 |
Adhesive, liquid or equal, any type, per oz |
53 |
48 |
$670.89 |
| A4663 |
Blood pressure cuff only |
35 |
32 |
$510.72 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
25 |
25 |
$366.30 |
| L3960 |
Shoulder elbow wrist hand orthosis, abduction positioning, airplane design, prefabricated, includes fitting and adjustment |
35 |
34 |
$328.99 |
| L3916 |
Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf |
13 |
12 |
$97.24 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
12 |
12 |
$4.21 |
| 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 |
1,448 |
1,386 |
$0.01 |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
49 |
43 |
$0.00 |
| L1971 |
Ankle foot orthosis, plastic or other material with ankle joint, with or without dorsiflexion assist, prefabricated, includes fitting and adjustment |
23 |
13 |
$0.00 |
| A4335 |
Incontinence supply; miscellaneous |
6,156 |
6,125 |
$0.00 |