| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4351 |
Straight tip urine catheter |
15,218 |
11,642 |
$1.14M |
| T4522 |
Adult size brief/diaper med |
13,326 |
8,911 |
$1.01M |
| T4521 |
Adult size brief/diaper sm |
9,691 |
6,428 |
$734K |
| A4353 |
Intermittent urinary cath |
2,822 |
1,890 |
$687K |
| E0603 |
Electric breast pump |
3,159 |
3,112 |
$662K |
| A4352 |
Coude tip urinary catheter |
2,641 |
1,898 |
$526K |
| T4530 |
Ped size brief/diaper lg |
9,245 |
6,320 |
$518K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
7,238 |
6,113 |
$404K |
| T4523 |
Adult size brief/diaper lg |
4,491 |
3,030 |
$291K |
| A5061 |
Pouch drainable w barrier at |
6,031 |
4,878 |
$270K |
| A4927 |
Non-sterile gloves |
20,281 |
16,628 |
$254K |
| A6212 |
Foam drg <=16 sq in w/border |
1,442 |
1,240 |
$241K |
| A5063 |
Drain ostomy pouch w/flange |
6,877 |
5,815 |
$241K |
| A6197 |
Alginate drsg >16 <=48 sq in |
933 |
822 |
$219K |
| A4385 |
Ost skn barrier sld ext wear |
5,212 |
4,486 |
$215K |
| A4409 |
Ost skn barr convex <=4 sq i |
3,582 |
3,074 |
$165K |
| A4407 |
Ext wear ost skn barr <=4sq" |
2,098 |
1,826 |
$140K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
1,606 |
1,417 |
$128K |
| A6216 |
Non-sterile gauze<=16 sq in |
5,996 |
5,215 |
$119K |
| A4362 |
Solid skin barrier |
5,917 |
4,956 |
$112K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
589 |
531 |
$105K |
| A4217 |
Sterile water/saline, 500 ml |
3,492 |
3,117 |
$97K |
| A5121 |
Solid skin barrier 6x6 |
1,629 |
1,449 |
$93K |
| A5071 |
Urinary pouch w/barrier |
928 |
783 |
$87K |
| A6196 |
Alginate dressing <=16 sq in |
658 |
586 |
$87K |
| A4349 |
Disposable male external cat |
3,313 |
2,821 |
$86K |
| A6402 |
Sterile gauze <= 16 sq in |
7,735 |
6,661 |
$82K |
| A4357 |
Bedside drainage bag |
8,554 |
7,383 |
$73K |
| A4425 |
Ost pch drain for barrier fl |
3,323 |
2,772 |
$72K |
| A4216 |
Sterile water/saline, 10 ml |
4,726 |
4,081 |
$65K |
| A4452 |
Waterproof tape |
6,328 |
5,303 |
$63K |
| A6446 |
Conform band s w>=3" <5"/yd |
2,109 |
1,855 |
$60K |
| A4456 |
Adhesive remover, wipes |
8,151 |
6,968 |
$59K |
| A4338 |
Indwelling catheter latex |
3,385 |
3,067 |
$54K |
| T4524 |
Adult size brief/diaper xl |
745 |
494 |
$52K |
| A5120 |
Skin barrier, wipe or swab |
10,793 |
9,113 |
$46K |
| A4354 |
Cath insertion tray w/bag |
2,629 |
2,394 |
$42K |
| A4373 |
Skin barrier with flange |
609 |
547 |
$40K |
| T4527 |
Adult size pull-on lg |
1,000 |
851 |
$39K |
| T4526 |
Adult size pull-on med |
940 |
790 |
$38K |
| A4427 |
Ost pch drain/barr lk flng/f |
1,140 |
1,056 |
$37K |
| T4541 |
Large disposable underpad |
1,716 |
1,528 |
$36K |
| A4358 |
Urinary leg or abdomen bag |
5,699 |
4,895 |
$36K |
| A4424 |
Ost pch drain w bar & filter |
1,020 |
833 |
$34K |
| A4394 |
Ostomy pouch liq deodorant |
3,251 |
2,705 |
$33K |
| T4535 |
Disposable liner/shield/pad |
1,240 |
1,043 |
$29K |
| T4528 |
Adult size pull-on xl |
483 |
405 |
$28K |
| B4036 |
Enteral feed sup kit grav by |
915 |
792 |
$26K |
| A4389 |
Drainable pch w st wear barr |
420 |
377 |
$26K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
15 |
12 |
$25K |
| K0553 |
Ther cgm supply allowance |
716 |
650 |
$25K |
| A4344 |
Cath indw foley 2 way silicn |
816 |
735 |
$24K |
| A4450 |
Non-waterproof tape |
7,616 |
6,628 |
$24K |
| A4402 |
Lubricant per ounce |
7,635 |
5,547 |
$20K |
| A6021 |
Collagen dressing <=16 sq in |
89 |
79 |
$20K |
| A6219 |
Gauze <= 16 sq in w/border |
851 |
746 |
$19K |
| A4421 |
Ostomy supply misc |
69 |
53 |
$14K |
| A4406 |
Pectin based ostomy paste |
2,899 |
2,357 |
$13K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
193 |
185 |
$12K |
| A4400 |
Ostomy irrigation set |
155 |
127 |
$11K |
| A4314 |
Cath w/drainage 2-way latex |
1,639 |
1,426 |
$11K |
| A9900 |
Supply/accessory/service |
1,818 |
1,523 |
$10K |
| A6198 |
Alginate dressing > 48 sq in |
15 |
13 |
$10K |
| A4432 |
Os pch urine w bar/fange/tap |
503 |
454 |
$9K |
| A4367 |
Ostomy belt |
2,309 |
1,997 |
$8K |
| A4322 |
Irrigation syringe |
395 |
324 |
$6K |
| A4371 |
Skin barrier powder per oz |
2,949 |
2,467 |
$5K |
| A4413 |
2 pc drainable ost pouch |
49 |
49 |
$5K |
| A9276 |
Disposable sensor, cgm sys |
34 |
26 |
$5K |
| A4419 |
Ost pch for bar w flange/flt |
139 |
119 |
$5K |
| A4239 |
Non-adju cgm supply allow |
143 |
133 |
$5K |
| A5054 |
Clsd ostomy pouch w/flange |
76 |
60 |
$4K |
| A4253 |
Blood glucose/reagent strips |
63 |
52 |
$3K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
97 |
82 |
$3K |
| T4525 |
Adult size pull-on sm |
71 |
47 |
$3K |
| A4455 |
Adhesive remover per ounce |
733 |
666 |
$3K |
| A6449 |
Lt compres band >=3" <5"/yd |
46 |
40 |
$2K |
| A4369 |
Skin barrier liquid per oz |
667 |
580 |
$2K |
| A5056 |
1 pc ost pouch w filter |
44 |
36 |
$2K |
| B4081 |
Enteral ng tubing w/ stylet |
15 |
14 |
$1K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
12 |
12 |
$959.17 |
| A4333 |
Urinary cath anchor device |
116 |
106 |
$638.57 |
| A6443 |
Conform band n/s w>=3"<5"/yd |
40 |
38 |
$490.30 |
| A4315 |
Cath w/drainage 2-way silcne |
30 |
26 |
$425.96 |
| A4364 |
Adhesive, liquid or equal |
111 |
91 |
$406.16 |
| A6454 |
Self-adher band w>=3" <5"/yd |
26 |
25 |
$251.92 |
| A4332 |
Lube sterile packet |
148 |
130 |
$242.41 |
| A4213 |
20+ cc syringe only |
120 |
114 |
$236.97 |
| A4405 |
Nonpectin based ostomy paste |
15 |
13 |
$133.46 |