| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
508,279 |
471,066 |
$29.88M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
336,767 |
309,919 |
$26.10M |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
460,997 |
430,661 |
$24.98M |
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
52,328 |
40,422 |
$18.65M |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
734,870 |
679,386 |
$17.92M |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
124,081 |
115,045 |
$14.63M |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
149,330 |
141,678 |
$13.47M |
| T4541 |
Incontinence product, disposable underpad, large, each |
274,851 |
252,232 |
$9.15M |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
110,214 |
104,235 |
$8.42M |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
122,853 |
114,005 |
$8.42M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
138,429 |
128,982 |
$8.15M |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
50,605 |
46,500 |
$7.74M |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
12,918 |
10,414 |
$7.28M |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
112,572 |
104,882 |
$6.72M |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
113,173 |
105,499 |
$5.60M |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
44,375 |
38,105 |
$5.46M |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
100,472 |
94,598 |
$5.39M |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
71,940 |
66,628 |
$5.03M |
| A9277 |
Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
14,254 |
11,509 |
$4.52M |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
38,661 |
30,842 |
$4.40M |
| 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 |
11,906 |
9,925 |
$3.82M |
| A4927 |
Gloves, non-sterile, per 100 |
359,574 |
287,034 |
$3.56M |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
30,729 |
26,934 |
$3.55M |
| A9274 |
External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories |
5,163 |
4,272 |
$3.51M |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
21,520 |
16,529 |
$3.49M |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
98,738 |
88,182 |
$3.36M |
| 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 |
49,270 |
34,437 |
$2.97M |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
316,222 |
225,145 |
$2.48M |
| 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 |
26,813 |
18,103 |
$2.26M |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
8,026 |
6,581 |
$2.22M |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
33,977 |
31,694 |
$2.10M |
| A4335 |
Incontinence supply; miscellaneous |
71,356 |
63,866 |
$1.98M |
| 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 |
22,188 |
18,386 |
$1.97M |
| 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 |
7,039 |
5,297 |
$1.91M |
| 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 |
22,685 |
16,269 |
$1.84M |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
13,569 |
11,123 |
$1.84M |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
8,799 |
7,168 |
$1.84M |
| A4352 |
Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each |
5,167 |
4,020 |
$1.82M |
| A4670 |
Automatic blood pressure monitor |
38,733 |
33,164 |
$1.57M |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
23,908 |
18,789 |
$1.45M |
| 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 |
10,442 |
7,856 |
$1.41M |
| A4554 |
Disposable underpads, all sizes |
70,207 |
53,830 |
$1.39M |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
24,477 |
19,442 |
$1.33M |
| 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 |
7,838 |
5,785 |
$1.21M |
| A4452 |
Tape, waterproof, per 18 square inches |
49,171 |
40,060 |
$1.10M |
| A9278 |
Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
3,196 |
2,500 |
$1.01M |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
33,186 |
27,116 |
$948K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
10,134 |
7,422 |
$880K |
| A4230 |
Infusion set for external insulin pump, non needle cannula type |
7,511 |
5,689 |
$803K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
19,705 |
14,502 |
$703K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
47,089 |
39,549 |
$697K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
9,383 |
7,218 |
$669K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
16,993 |
13,151 |
$611K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
13,335 |
10,032 |
$568K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
9,594 |
8,875 |
$563K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
52,002 |
42,181 |
$497K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
18,370 |
14,454 |
$464K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
58,471 |
45,801 |
$417K |
| E0784 |
External ambulatory infusion pump, insulin |
306 |
204 |
$415K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
3,350 |
3,007 |
$406K |
| T4531 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
5,003 |
4,662 |
$355K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
12,938 |
9,866 |
$338K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
43,098 |
32,875 |
$334K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
7,227 |
5,772 |
$331K |
| 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 |
4,949 |
3,913 |
$322K |
| A6211 |
Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
563 |
453 |
$321K |
| A6260 |
Wound cleansers, any type, any size |
22,609 |
17,405 |
$309K |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
4,137 |
3,242 |
$302K |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
3,287 |
2,467 |
$290K |
| A4388 |
Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each |
5,055 |
3,955 |
$272K |
| A5120 |
Skin barrier, wipes or swabs, each |
47,596 |
37,520 |
$264K |
| A6258 |
Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
4,403 |
3,647 |
$263K |
| A4232 |
Syringe with needle for external insulin pump, sterile, 3 cc |
7,561 |
5,897 |
$256K |
| A4217 |
Sterile water/saline, 500 ml |
34,513 |
27,374 |
$248K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
7,145 |
5,193 |
$248K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
6,363 |
4,940 |
$234K |
| A4456 |
Adhesive remover, wipes, any type, each |
35,785 |
28,379 |
$230K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
5,192 |
4,181 |
$230K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
23,027 |
18,356 |
$221K |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
8,174 |
6,469 |
$217K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
6,476 |
4,963 |
$203K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
19,514 |
14,791 |
$200K |
| A4553 |
Non-disposable underpads, all sizes |
15,758 |
13,935 |
$193K |
| K0554 |
Receiver (monitor), dedicated, for use with therapeutic glucose continuous monitor system |
1,763 |
1,420 |
$190K |
| A6199 |
Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches |
1,907 |
1,529 |
$185K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
23,883 |
18,509 |
$173K |
| B4102 |
Enteral formula, for adults, used to replace fluids and electrolytes (e.g., clear liquids), 500 ml = 1 unit |
1,528 |
1,139 |
$169K |
| T4529 |
Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
2,665 |
2,402 |
$168K |
| E2103 |
Non-adjunctive, non-implanted continuous glucose monitor or receiver |
1,970 |
1,545 |
$167K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
2,519 |
2,009 |
$165K |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
3,003 |
2,365 |
$150K |
| E0607 |
Home blood glucose monitor |
5,079 |
4,083 |
$149K |
| A6207 |
Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
1,407 |
1,044 |
$149K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,181 |
1,623 |
$149K |
| A4354 |
Insertion tray with drainage bag but without catheter |
2,671 |
2,080 |
$141K |
| A6010 |
Collagen based wound filler, dry form, sterile, per gram of collagen |
635 |
498 |
$141K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
24,978 |
20,385 |
$139K |
| A4332 |
Lubricant, individual sterile packet, each |
18,092 |
13,899 |
$135K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
6,577 |
4,979 |
$135K |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
2,516 |
1,972 |
$124K |
| A4259 |
Lancets, per box of 100 |
42,293 |
35,866 |
$123K |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
4,028 |
3,160 |
$121K |
| A6452 |
High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard |
638 |
458 |
$120K |
| A4410 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each |
1,425 |
1,141 |
$115K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
6,022 |
4,590 |
$107K |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
2,722 |
2,187 |
$104K |
| A4402 |
Lubricant, per ounce |
12,938 |
10,301 |
$101K |
| A6022 |
Collagen dressing, sterile, size more than 16 sq. in. but less than or equal to 48 sq. in., each |
348 |
282 |
$100K |
| A4430 |
Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each |
2,569 |
1,655 |
$97K |
| A6237 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
1,373 |
960 |
$95K |
| A6220 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
1,298 |
990 |
$93K |
| A4390 |
Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each |
1,106 |
747 |
$90K |
| A4416 |
Ostomy pouch, closed, with barrier attached, with filter (1 piece), each |
1,256 |
1,006 |
$87K |
| B4100 |
Food thickener, administered orally, per ounce |
5,123 |
3,260 |
$86K |
| A4256 |
Normal, low and high calibrator solution / chips |
32,159 |
27,493 |
$82K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
5,387 |
4,096 |
$79K |
| A4231 |
Infusion set for external insulin pump, needle type |
868 |
633 |
$71K |
| W0137 |
|
2,580 |
2,472 |
$71K |
| A4373 |
Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each |
1,506 |
1,143 |
$69K |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
3,321 |
2,710 |
$68K |
| A4371 |
Ostomy skin barrier, powder, per oz |
19,370 |
15,841 |
$62K |
| A6403 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing |
1,749 |
1,345 |
$62K |
| A4428 |
Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (1 piece), each |
931 |
722 |
$56K |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
4,743 |
4,237 |
$55K |
| A4245 |
Alcohol wipes, per box |
16,202 |
14,183 |
$52K |
| A4247 |
Betadine or iodine swabs/wipes, per box |
4,826 |
3,770 |
$52K |
| A6456 |
Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
1,031 |
704 |
$49K |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
4,065 |
3,200 |
$49K |
| A4649 |
Surgical supply; miscellaneous |
246 |
207 |
$47K |
| A4389 |
Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each |
589 |
446 |
$44K |
| A5054 |
Ostomy pouch, closed; for use on barrier with flange (2 piece), each |
1,472 |
1,085 |
$43K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
2,020 |
1,885 |
$42K |
| A6441 |
Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard |
1,773 |
1,368 |
$42K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
1,610 |
1,489 |
$41K |
| A6450 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard |
1,195 |
958 |
$34K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
1,671 |
1,370 |
$33K |
| A6445 |
Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard |
1,928 |
1,548 |
$33K |
| A4367 |
Ostomy belt, each |
8,095 |
6,359 |
$32K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
4,595 |
3,775 |
$32K |
| A6198 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 48 sq. in., each dressing |
81 |
63 |
$30K |
| A4427 |
Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each |
889 |
742 |
$30K |
| A4322 |
Irrigation syringe, bulb or piston, each |
2,867 |
2,319 |
$29K |
| E1399 |
Durable medical equipment, miscellaneous |
967 |
673 |
$28K |
| A4399 |
Ostomy irrigation supply; cone/catheter, with or without brush |
1,351 |
1,141 |
$27K |
| A4398 |
Ostomy irrigation supply; bag, each |
1,481 |
1,229 |
$25K |
| A4415 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 inches, each |
372 |
301 |
$20K |
| A6240 |
Hydrocolloid dressing, wound filler, paste, sterile, per ounce |
585 |
523 |
$19K |
| A6206 |
Contact layer, sterile, 16 sq. in. or less, each dressing |
157 |
110 |
$18K |
| A4315 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone |
626 |
523 |
$17K |
| A6251 |
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
901 |
675 |
$16K |
| A4258 |
Spring-powered device for lancet, each |
4,984 |
4,219 |
$15K |
| A5121 |
Skin barrier; solid, 6 x 6 or equivalent, each |
318 |
255 |
$14K |
| A4246 |
Betadine or phisohex solution, per pint |
1,313 |
1,100 |
$14K |
| A4364 |
Adhesive, liquid or equal, any type, per oz |
1,968 |
1,534 |
$13K |
| E1639 |
Scale, each |
364 |
315 |
$12K |
| A6407 |
Packing strips, non-impregnated, sterile, up to 2 inches in width, per linear yard |
652 |
504 |
$12K |
| A4213 |
Syringe, sterile, 20 cc or greater, each |
1,382 |
1,103 |
$12K |
| A4340 |
Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each |
348 |
312 |
$11K |
| A4311 |
Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
1,384 |
1,010 |
$11K |
| E0325 |
Urinal; male, jug-type, any material |
3,083 |
2,210 |
$9K |
| T4536 |
Incontinence product, protective underwear/pull-on, reusable, any size, each |
539 |
527 |
$7K |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
2,198 |
1,641 |
$6K |
| A5131 |
Appliance cleaner, incontinence and ostomy appliances, per 16 oz. |
1,393 |
990 |
$6K |
| A4393 |
Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity (1 piece), each |
62 |
51 |
$6K |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
1,426 |
1,074 |
$4K |
| A4459 |
Manual transanal irrigation system, includes water reservoir, pump, tubing, and accessories, without catheter, any type |
12 |
12 |
$4K |
| E0445 |
Oximeter device for measuring blood oxygen levels non-invasively |
143 |
133 |
$4K |
| A4412 |
Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), without filter, each |
113 |
102 |
$3K |
| A4331 |
Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
523 |
479 |
$3K |
| A6453 |
Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard |
71 |
51 |
$2K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
33 |
24 |
$2K |
| A6203 |
Composite dressing, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
44 |
39 |
$1K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
181 |
162 |
$1K |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
53 |
47 |
$647.10 |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
328 |
296 |
$589.66 |
| A4225 |
Supplies for external insulin infusion pump, syringe type cartridge, sterile, each |
174 |
173 |
$581.61 |
| A9901 |
Dme delivery, set up, and/or dispensing service component of another hcpcs code |
770 |
770 |
$411.60 |
| A4396 |
Ostomy belt with peristomal hernia support |
13 |
12 |
$382.35 |
| A6261 |
Wound filler, gel/paste, per fluid ounce, not otherwise specified |
17 |
12 |
$193.67 |
| K0552 |
Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each |
29 |
12 |
$164.16 |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
260 |
209 |
$9.78 |
| A4293 |
|
14 |
12 |
$0.00 |
| A9270 |
Non-covered item or service |
1,113 |
1,082 |
$0.00 |