| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4649 |
Surgical supply; miscellaneous |
792 |
587 |
$810K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
4,747 |
4,402 |
$531K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
4,359 |
3,930 |
$512K |
| A4927 |
Gloves, non-sterile, per 100 |
26,942 |
24,605 |
$413K |
| T4541 |
Incontinence product, disposable underpad, large, each |
11,250 |
10,009 |
$390K |
| E1399 |
Durable medical equipment, miscellaneous |
807 |
472 |
$363K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
1,395 |
1,259 |
$349K |
| B4100 |
Food thickener, administered orally, per ounce |
1,139 |
764 |
$329K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
2,473 |
2,188 |
$237K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,580 |
1,450 |
$168K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,671 |
1,550 |
$167K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
3,707 |
3,217 |
$146K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
963 |
903 |
$104K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
5,399 |
4,894 |
$95K |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
1,854 |
728 |
$75K |
| 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 |
769 |
679 |
$28K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
1,598 |
1,297 |
$28K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
1,241 |
1,008 |
$23K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
1,289 |
1,082 |
$22K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,579 |
1,397 |
$21K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
50 |
49 |
$15K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
1,950 |
1,674 |
$12K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
136 |
124 |
$10K |
| A4452 |
Tape, waterproof, per 18 square inches |
597 |
470 |
$8K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
174 |
138 |
$8K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
70 |
61 |
$6K |
| A4217 |
Sterile water/saline, 500 ml |
1,799 |
1,613 |
$6K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,198 |
1,037 |
$5K |
| A7048 |
Vacuum drainage collection unit and tubing kit, including all supplies needed for collection unit change, for use with implanted catheter, each |
24 |
12 |
$5K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,003 |
874 |
$5K |
| A5120 |
Skin barrier, wipes or swabs, each |
1,913 |
1,514 |
$4K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
888 |
792 |
$3K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
246 |
209 |
$2K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
467 |
418 |
$2K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
517 |
424 |
$2K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
67 |
52 |
$2K |
| 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 |
93 |
87 |
$1K |
| A4389 |
Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each |
25 |
25 |
$1K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
38 |
38 |
$746.48 |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
18 |
12 |
$476.08 |
| A4456 |
Adhesive remover, wipes, any type, each |
122 |
90 |
$227.96 |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
15 |
12 |
$64.83 |
| A4371 |
Ostomy skin barrier, powder, per oz |
14 |
13 |
$31.14 |