| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
19,132 |
18,354 |
$1.65M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
16,861 |
16,139 |
$1.31M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
19,730 |
18,791 |
$1.26M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
12,799 |
12,204 |
$1.18M |
| A4927 |
Gloves, non-sterile, per 100 |
61,735 |
55,820 |
$982K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
3,798 |
3,146 |
$673K |
| 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 |
1,793 |
1,399 |
$472K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
11,464 |
11,000 |
$225K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
2,075 |
1,417 |
$209K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
2,146 |
2,029 |
$195K |
| T4541 |
Incontinence product, disposable underpad, large, each |
10,389 |
9,988 |
$194K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
2,334 |
2,188 |
$191K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
854 |
732 |
$157K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
1,695 |
1,331 |
$124K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
2,691 |
2,533 |
$119K |
| 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 |
350 |
299 |
$111K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
3,194 |
2,614 |
$77K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,186 |
1,134 |
$66K |
| 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 |
1,373 |
1,158 |
$62K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
480 |
457 |
$35K |
| A4452 |
Tape, waterproof, per 18 square inches |
2,613 |
2,106 |
$30K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
245 |
151 |
$27K |
| 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 |
124 |
112 |
$22K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
257 |
250 |
$16K |
| 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 |
129 |
84 |
$12K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
177 |
157 |
$10K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
294 |
255 |
$10K |
| 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 |
141 |
126 |
$9K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,395 |
1,715 |
$7K |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
108 |
96 |
$5K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
126 |
98 |
$5K |
| A6199 |
Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches |
14 |
14 |
$3K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
5,039 |
3,541 |
$3K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
854 |
738 |
$3K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
15 |
12 |
$3K |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
17 |
13 |
$1K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
205 |
169 |
$834.20 |
| K0001 |
Standard wheelchair |
78 |
51 |
$816.22 |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
265 |
165 |
$597.28 |
| A4456 |
Adhesive remover, wipes, any type, each |
90 |
69 |
$520.07 |
| A5120 |
Skin barrier, wipes or swabs, each |
118 |
90 |
$412.67 |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
32 |
28 |
$403.32 |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
106 |
86 |
$335.06 |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
13 |
12 |
$162.26 |
| A4554 |
Disposable underpads, all sizes |
1,315 |
1,112 |
$141.64 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
57 |
45 |
$107.85 |