| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
508,279 |
471,066 |
$29.88M |
| T4528 |
Adult size pull-on xl |
336,767 |
309,919 |
$26.10M |
| T4526 |
Adult size pull-on med |
460,997 |
430,661 |
$24.98M |
| A9276 |
Disposable sensor, cgm sys |
52,328 |
40,422 |
$18.65M |
| T4535 |
Disposable liner/shield/pad |
734,870 |
679,386 |
$17.92M |
| T4544 |
Adlt disp und/pull on abv xl |
124,081 |
115,045 |
$14.63M |
| T4534 |
Youth size pull-on |
149,330 |
141,678 |
$13.47M |
| T4541 |
Large disposable underpad |
274,851 |
252,232 |
$9.15M |
| T4532 |
Ped size pull-on lg |
110,214 |
104,235 |
$8.42M |
| T4523 |
Adult size brief/diaper lg |
122,853 |
114,005 |
$8.42M |
| T4522 |
Adult size brief/diaper med |
138,429 |
128,982 |
$8.15M |
| T4543 |
Adult disp brief/diap abv xl |
50,605 |
46,500 |
$7.74M |
| A4353 |
Intermittent urinary cath |
12,918 |
10,414 |
$7.28M |
| T4525 |
Adult size pull-on sm |
112,572 |
104,882 |
$6.72M |
| T4537 |
Reusable underpad bed size |
113,173 |
105,499 |
$5.60M |
| A4239 |
Non-adju cgm supply allow |
44,375 |
38,105 |
$5.46M |
| T4530 |
Ped size brief/diaper lg |
100,472 |
94,598 |
$5.39M |
| T4524 |
Adult size brief/diaper xl |
71,940 |
66,628 |
$5.03M |
| A9277 |
External transmitter, cgm |
14,254 |
11,509 |
$4.52M |
| A4351 |
Straight tip urine catheter |
38,661 |
30,842 |
$4.40M |
| A6197 |
Alginate drsg >16 <=48 sq in |
11,906 |
9,925 |
$3.82M |
| A4927 |
Non-sterile gloves |
359,574 |
287,034 |
$3.56M |
| K0553 |
Ther cgm supply allowance |
30,729 |
26,934 |
$3.55M |
| A9274 |
Ext amb insulin delivery sys |
5,163 |
4,272 |
$3.51M |
| A6212 |
Foam drg <=16 sq in w/border |
21,520 |
16,529 |
$3.49M |
| A4520 |
Incontinence garment anytype |
98,738 |
88,182 |
$3.36M |
| B4150 |
Ef complet w/intact nutrient |
49,270 |
34,437 |
$2.97M |
| A6250 |
Skin seal protect moisturizr |
316,222 |
225,145 |
$2.48M |
| B4154 |
Ef spec metabolic noninherit |
26,813 |
18,103 |
$2.26M |
| A6021 |
Collagen dressing <=16 sq in |
8,026 |
6,581 |
$2.22M |
| T4521 |
Adult size brief/diaper sm |
33,977 |
31,694 |
$2.10M |
| A4335 |
Incontinence supply |
71,356 |
63,866 |
$1.98M |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
22,188 |
18,386 |
$1.97M |
| A6210 |
Foam drg >16<=48 sq in w/o b |
7,039 |
5,297 |
$1.91M |
| B4152 |
Ef calorie dense>/=1.5kcal |
22,685 |
16,269 |
$1.84M |
| A6196 |
Alginate dressing <=16 sq in |
13,569 |
11,123 |
$1.84M |
| A6253 |
Absorpt drg > 48 sq in w/o b |
8,799 |
7,168 |
$1.84M |
| A4352 |
Coude tip urinary catheter |
5,167 |
4,020 |
$1.82M |
| A4670 |
Automatic bp monitor, dial |
38,733 |
33,164 |
$1.57M |
| A4409 |
Ost skn barr convex <=4 sq i |
23,908 |
18,789 |
$1.45M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
10,442 |
7,856 |
$1.41M |
| A4554 |
Disposable underpads |
70,207 |
53,830 |
$1.39M |
| A4385 |
Ost skn barrier sld ext wear |
24,477 |
19,442 |
$1.33M |
| A6213 |
Foam drg >16<=48 sq in w/bdr |
7,838 |
5,785 |
$1.21M |
| A4452 |
Waterproof tape |
49,171 |
40,060 |
$1.10M |
| A9278 |
External receiver, cgm sys |
3,196 |
2,500 |
$1.01M |
| A6446 |
Conform band s w>=3" <5"/yd |
33,186 |
27,116 |
$948K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
10,134 |
7,422 |
$880K |
| A4230 |
Infus insulin pump non needl |
7,511 |
5,689 |
$803K |
| A4349 |
Disposable male external cat |
19,705 |
14,502 |
$703K |
| A4253 |
Blood glucose/reagent strips |
47,089 |
39,549 |
$697K |
| A4407 |
Ext wear ost skn barr <=4sq" |
9,383 |
7,218 |
$669K |
| A4425 |
Ost pch drain for barrier fl |
16,993 |
13,151 |
$611K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
13,335 |
10,032 |
$568K |
| T4533 |
Youth size brief/diaper |
9,594 |
8,875 |
$563K |
| A6402 |
Sterile gauze <= 16 sq in |
52,002 |
42,181 |
$497K |
| A5063 |
Drain ostomy pouch w/flange |
18,370 |
14,454 |
$464K |
| A6216 |
Non-sterile gauze<=16 sq in |
58,471 |
45,801 |
$417K |
| E0784 |
Ext amb infusn pump insulin |
306 |
204 |
$415K |
| E0603 |
Electric breast pump |
3,350 |
3,007 |
$406K |
| T4531 |
Ped size pull-on sm/med |
5,003 |
4,662 |
$355K |
| A4362 |
Solid skin barrier |
12,938 |
9,866 |
$338K |
| A4357 |
Bedside drainage bag |
43,098 |
32,875 |
$334K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
7,227 |
5,772 |
$331K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
4,949 |
3,913 |
$322K |
| A6211 |
Foam drg > 48 sq in w/o brdr |
563 |
453 |
$321K |
| A6260 |
Wound cleanser any type/size |
22,609 |
17,405 |
$309K |
| A4344 |
Cath indw foley 2 way silicn |
4,137 |
3,242 |
$302K |
| A5057 |
1 pc ost pou w built-in conv |
3,287 |
2,467 |
$290K |
| A4388 |
Drainable pch w ex wear barr |
5,055 |
3,955 |
$272K |
| A5120 |
Skin barrier, wipe or swab |
47,596 |
37,520 |
$264K |
| A6258 |
Transparent film >16<=48 in |
4,403 |
3,647 |
$263K |
| A4232 |
Syringe w/needle insulin 3cc |
7,561 |
5,897 |
$256K |
| A4217 |
Sterile water/saline, 500 ml |
34,513 |
27,374 |
$248K |
| A4419 |
Ost pch for bar w flange/flt |
7,145 |
5,193 |
$248K |
| A4432 |
Os pch urine w bar/fange/tap |
6,363 |
4,940 |
$234K |
| A4456 |
Adhesive remover, wipes |
35,785 |
28,379 |
$230K |
| A5061 |
Pouch drainable w barrier at |
5,192 |
4,181 |
$230K |
| A4406 |
Pectin based ostomy paste |
23,027 |
18,356 |
$221K |
| A6449 |
Lt compres band >=3" <5"/yd |
8,174 |
6,469 |
$217K |
| A6219 |
Gauze <= 16 sq in w/border |
6,476 |
4,963 |
$203K |
| A4394 |
Ostomy pouch liq deodorant |
19,514 |
14,791 |
$200K |
| A4553 |
Nondisp underpads, all sizes |
15,758 |
13,935 |
$193K |
| K0554 |
Ther cgm receiver/monitor |
1,763 |
1,420 |
$190K |
| A6199 |
Alginate drsg wound filler |
1,907 |
1,529 |
$185K |
| A4358 |
Urinary leg or abdomen bag |
23,883 |
18,509 |
$173K |
| B4102 |
Ef adult fluids and electro |
1,528 |
1,139 |
$169K |
| T4529 |
Ped size brief/diaper sm/med |
2,665 |
2,402 |
$168K |
| E2103 |
Non-adju cgm receiver/mon |
1,970 |
1,545 |
$167K |
| A6266 |
Impreg gauze no h20/sal/yard |
2,519 |
2,009 |
$165K |
| A5056 |
1 pc ost pouch w filter |
3,003 |
2,365 |
$150K |
| E0607 |
Blood glucose monitor home |
5,079 |
4,083 |
$149K |
| A6207 |
Contact layer >16<= 48 sq in |
1,407 |
1,044 |
$149K |
| A6234 |
Hydrocolld drg <=16 w/o bdr |
2,181 |
1,623 |
$149K |
| A4354 |
Cath insertion tray w/bag |
2,671 |
2,080 |
$141K |
| A6010 |
Collagen based wound filler |
635 |
498 |
$141K |
| A4450 |
Non-waterproof tape |
24,978 |
20,385 |
$139K |
| A4332 |
Lube sterile packet |
18,092 |
13,899 |
$135K |
| A4310 |
Insert tray w/o bag/cath |
6,577 |
4,979 |
$135K |
| A4424 |
Ost pch drain w bar & filter |
2,516 |
1,972 |
$124K |
| A4259 |
Lancets per box |
42,293 |
35,866 |
$123K |
| A6454 |
Self-adher band w>=3" <5"/yd |
4,028 |
3,160 |
$121K |
| A6452 |
High compres band w>=3"<5"yd |
638 |
458 |
$120K |
| A4410 |
Ost skn barr extnd >4 sq |
1,425 |
1,141 |
$115K |
| A4338 |
Indwelling catheter latex |
6,022 |
4,590 |
$107K |
| A6248 |
Hydrogel drsg gel filler |
2,722 |
2,187 |
$104K |
| A4402 |
Lubricant per ounce |
12,938 |
10,301 |
$101K |
| A6022 |
Collagen drsg>16<=48 sq in |
348 |
282 |
$100K |
| A4430 |
Ost urine pch w b/bltin conv |
2,569 |
1,655 |
$97K |
| A6237 |
Hydrocolld drg <=16 in w/bdr |
1,373 |
960 |
$95K |
| A6220 |
Gauze >16 <=48 sq in w/bordr |
1,298 |
990 |
$93K |
| A4390 |
Drainable pch ex wear convex |
1,106 |
747 |
$90K |
| A4416 |
Ost pch clsd w barrier/filtr |
1,256 |
1,006 |
$87K |
| B4100 |
Food thickener oral |
5,123 |
3,260 |
$86K |
| A4256 |
Calibrator solution/chips |
32,159 |
27,493 |
$82K |
| A4314 |
Cath w/drainage 2-way latex |
5,387 |
4,096 |
$79K |
| A4231 |
Infusion insulin pump needle |
868 |
633 |
$71K |
| W0137 |
|
2,580 |
2,472 |
$71K |
| A4373 |
Skin barrier with flange |
1,506 |
1,143 |
$69K |
| A4320 |
Irrigation tray |
3,321 |
2,710 |
$68K |
| A4371 |
Skin barrier powder per oz |
19,370 |
15,841 |
$62K |
| A6403 |
Sterile gauze>16 <= 48 sq in |
1,749 |
1,345 |
$62K |
| A4428 |
Urine ost pouch w faucet/tap |
931 |
722 |
$56K |
| A9286 |
Any hygienic item, device |
4,743 |
4,237 |
$55K |
| A4245 |
Alcohol wipes per box |
16,202 |
14,183 |
$52K |
| A4247 |
Betadine/iodine swabs/wipes |
4,826 |
3,770 |
$52K |
| A6456 |
Zinc paste band w >=3"<5"/yd |
1,031 |
704 |
$49K |
| A6457 |
Tubular dressing |
4,065 |
3,200 |
$49K |
| A4649 |
Surgical supplies |
246 |
207 |
$47K |
| A4389 |
Drainable pch w st wear barr |
589 |
446 |
$44K |
| A5054 |
Clsd ostomy pouch w/flange |
1,472 |
1,085 |
$43K |
| T4542 |
Small disposable underpad |
2,020 |
1,885 |
$42K |
| A6441 |
Pad band w>=3" <5"/yd |
1,773 |
1,368 |
$42K |
| T4540 |
Reusable underpad chair size |
1,610 |
1,489 |
$41K |
| A6450 |
Lt compres band >=5"/yd |
1,195 |
958 |
$34K |
| A6257 |
Transparent film <= 16 sq in |
1,671 |
1,370 |
$33K |
| A6445 |
Conform band s w <3"/yd |
1,928 |
1,548 |
$33K |
| A4367 |
Ostomy belt |
8,095 |
6,359 |
$32K |
| A4333 |
Urinary cath anchor device |
4,595 |
3,775 |
$32K |
| A6198 |
Alginate dressing > 48 sq in |
81 |
63 |
$30K |
| A4427 |
Ost pch drain/barr lk flng/f |
889 |
742 |
$30K |
| A4322 |
Irrigation syringe |
2,867 |
2,319 |
$29K |
| E1399 |
Durable medical equipment mi |
967 |
673 |
$28K |
| A4399 |
Ostomy irrig cone/cath w brs |
1,351 |
1,141 |
$27K |
| A4398 |
Ostomy irrigation bag |
1,481 |
1,229 |
$25K |
| A4415 |
Ost skn barr w/o conv >4 sqi |
372 |
301 |
$20K |
| A6240 |
Hydrocolld drg filler paste |
585 |
523 |
$19K |
| A6206 |
Contact layer <= 16 sq in |
157 |
110 |
$18K |
| A4315 |
Cath w/drainage 2-way silcne |
626 |
523 |
$17K |
| A6251 |
Absorpt drg <=16 sq in w/o b |
901 |
675 |
$16K |
| A4258 |
Lancet device each |
4,984 |
4,219 |
$15K |
| A5121 |
Solid skin barrier 6x6 |
318 |
255 |
$14K |
| A4246 |
Betadine/phisohex solution |
1,313 |
1,100 |
$14K |
| A4364 |
Adhesive, liquid or equal |
1,968 |
1,534 |
$13K |
| E1639 |
Scale, each |
364 |
315 |
$12K |
| A6407 |
Packing strips, non-impreg |
652 |
504 |
$12K |
| A4213 |
20+ cc syringe only |
1,382 |
1,103 |
$12K |
| A4340 |
Indwelling catheter special |
348 |
312 |
$11K |
| A4311 |
Catheter w/o bag 2-way latex |
1,384 |
1,010 |
$11K |
| E0325 |
Urinal male jug-type |
3,083 |
2,210 |
$9K |
| T4536 |
Reusable pull-on any size |
539 |
527 |
$7K |
| A4369 |
Skin barrier liquid per oz |
2,198 |
1,641 |
$6K |
| A5131 |
Appliance cleaner |
1,393 |
990 |
$6K |
| A4393 |
Urine pch w ex wear bar conv |
62 |
51 |
$6K |
| A4334 |
Urinary cath leg strap |
1,426 |
1,074 |
$4K |
| A4459 |
Transanal irrigation, any |
12 |
12 |
$4K |
| E0445 |
Oximeter non-invasive |
143 |
133 |
$4K |
| A4412 |
Ost pouch drain high output |
113 |
102 |
$3K |
| A4331 |
Extension drainage tubing |
523 |
479 |
$3K |
| A6453 |
Self-adher band w <3"/yd |
71 |
51 |
$2K |
| A4629 |
Tracheostomy care kit |
33 |
24 |
$2K |
| A6203 |
Composite drsg <= 16 sq in |
44 |
39 |
$1K |
| A4216 |
Sterile water/saline, 10 ml |
181 |
162 |
$1K |
| A6443 |
Conform band n/s w>=3"<5"/yd |
53 |
47 |
$647.10 |
| A4455 |
Adhesive remover per ounce |
328 |
296 |
$589.66 |
| A4225 |
Sup/ext insulin inf pump syr |
174 |
173 |
$581.61 |
| A9901 |
Delivery/set up/dispensing |
770 |
770 |
$411.60 |
| A4396 |
Peristomal hernia supprt blt |
13 |
12 |
$382.35 |
| A6261 |
Wound filler gel/paste /oz |
17 |
12 |
$193.67 |
| K0552 |
Sup/ext non-ins inf pump syr |
29 |
12 |
$164.16 |
| T2029 |
Special med equip, noswaiver |
260 |
209 |
$9.78 |
| A4293 |
|
14 |
12 |
$0.00 |
| A9270 |
Non-covered item or service |
1,113 |
1,082 |
$0.00 |