| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
11,777 |
11,165 |
$1.63M |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
10,620 |
9,919 |
$1.30M |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
13,425 |
12,801 |
$1.16M |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
9,447 |
8,951 |
$909K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
10,891 |
10,422 |
$907K |
| T4541 |
Incontinence product, disposable underpad, large, each |
19,043 |
18,664 |
$806K |
| A4927 |
Gloves, non-sterile, per 100 |
21,711 |
21,095 |
$602K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
1,867 |
1,777 |
$359K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
6,275 |
5,911 |
$350K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
2,197 |
2,102 |
$280K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
1,725 |
1,627 |
$223K |
| G9012 |
Other specified case management service not elsewhere classified |
10,189 |
8,119 |
$193K |
| B4100 |
Food thickener, administered orally, per ounce |
3,556 |
3,007 |
$142K |
| 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 |
827 |
734 |
$112K |
| 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 |
547 |
490 |
$90K |
| A4320 |
Irrigation tray with bulb or piston syringe, any purpose |
376 |
360 |
$83K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
833 |
808 |
$60K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
257 |
225 |
$43K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
4,027 |
3,437 |
$42K |
| A4211 |
Supplies for self-administered injections |
989 |
879 |
$34K |
| 99605 |
|
599 |
598 |
$23K |
| J7626 |
Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 0.5 mg |
1,178 |
1,139 |
$20K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,632 |
1,474 |
$17K |
| A4217 |
Sterile water/saline, 500 ml |
273 |
259 |
$13K |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
2,040 |
1,921 |
$12K |
| 99607 |
|
414 |
412 |
$11K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
1,222 |
1,091 |
$9K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
211 |
191 |
$8K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
397 |
304 |
$7K |
| 0012A |
|
1,681 |
1,665 |
$5K |
| B9998 |
Noc for enteral supplies |
75 |
66 |
$4K |
| 0011A |
|
1,636 |
1,627 |
$4K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
717 |
652 |
$3K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
226 |
198 |
$2K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
153 |
147 |
$2K |
| A4245 |
Alcohol wipes, per box |
234 |
226 |
$901.67 |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
47 |
42 |
$739.46 |
| J7620 |
Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme |
198 |
192 |
$541.02 |
| A4259 |
Lancets, per box of 100 |
123 |
119 |
$175.90 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
130 |
110 |
$146.63 |
| A9270 |
Non-covered item or service |
1,530 |
898 |
$0.00 |
| 90686 |
|
160 |
160 |
$0.00 |
| E0607 |
Home blood glucose monitor |
25 |
25 |
$0.00 |
| A4322 |
Irrigation syringe, bulb or piston, each |
25 |
12 |
$0.00 |