| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S8101 |
Holding chamber or spacer for use with an inhaler or nebulizer; with mask |
2,821 |
2,821 |
$156K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
748 |
744 |
$103K |
| A4554 |
Disposable underpads, all sizes |
632 |
624 |
$42K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
1,439 |
1,408 |
$40K |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
272 |
271 |
$32K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
177 |
177 |
$28K |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
971 |
967 |
$16K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
157 |
156 |
$15K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
196 |
194 |
$10K |
| A6206 |
Contact layer, sterile, 16 sq. in. or less, each dressing |
168 |
168 |
$8K |
| 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 |
21 |
21 |
$8K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
177 |
177 |
$7K |
| L1833 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
16 |
12 |
$6K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
315 |
314 |
$6K |
| A4217 |
Sterile water/saline, 500 ml |
315 |
314 |
$5K |
| A4930 |
Gloves, sterile, per pair |
246 |
244 |
$3K |
| A6257 |
Transparent film, sterile, 16 sq. in. or less, each dressing |
182 |
182 |
$2K |
| A4927 |
Gloves, non-sterile, per 100 |
298 |
291 |
$1K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
191 |
191 |
$945.90 |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
26 |
25 |
$688.04 |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
81 |
78 |
$535.40 |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
13 |
12 |
$524.90 |
| L2397 |
Addition to lower extremity orthosis, suspension sleeve |
34 |
26 |
$483.60 |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
16 |
15 |
$48.00 |