| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L4360 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
1,262 |
1,114 |
$229K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
1,217 |
1,068 |
$81K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
1,525 |
1,404 |
$65K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
1,421 |
1,280 |
$62K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
5,866 |
5,247 |
$54K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
499 |
408 |
$43K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
547 |
456 |
$42K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
1,564 |
1,403 |
$38K |
| A4452 |
Tape, waterproof, per 18 square inches |
2,759 |
2,434 |
$35K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
688 |
614 |
$33K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
1,193 |
1,074 |
$28K |
| L3670 |
Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf |
367 |
347 |
$27K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
407 |
344 |
$26K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
1,303 |
1,082 |
$26K |
| 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 |
599 |
522 |
$25K |
| A6260 |
Wound cleansers, any type, any size |
2,457 |
2,259 |
$23K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
466 |
413 |
$20K |
| L3807 |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
86 |
80 |
$13K |
| 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 |
63 |
51 |
$11K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
58 |
51 |
$8K |
| A4456 |
Adhesive remover, wipes, any type, each |
943 |
842 |
$7K |
| A5120 |
Skin barrier, wipes or swabs, each |
1,503 |
1,344 |
$6K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
681 |
610 |
$5K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
66 |
60 |
$4K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
640 |
558 |
$4K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
58 |
53 |
$4K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
155 |
132 |
$3K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
113 |
104 |
$3K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
457 |
402 |
$2K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
304 |
280 |
$2K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
828 |
760 |
$2K |
| L3660 |
Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf |
30 |
26 |
$2K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
16 |
13 |
$1K |
| 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 |
32 |
26 |
$1K |
| A4371 |
Ostomy skin barrier, powder, per oz |
400 |
353 |
$1K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
12 |
12 |
$568.96 |
| A6407 |
Packing strips, non-impregnated, sterile, up to 2 inches in width, per linear yard |
13 |
13 |
$481.20 |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
208 |
184 |
$393.48 |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
28 |
24 |
$284.50 |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
52 |
49 |
$215.49 |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
42 |
30 |
$0.00 |