| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
1,915 |
1,522 |
$316K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
5,837 |
4,690 |
$298K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
4,076 |
3,320 |
$261K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
2,300 |
1,823 |
$169K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
3,353 |
2,783 |
$122K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
1,101 |
897 |
$119K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
3,468 |
2,781 |
$111K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
1,856 |
1,409 |
$86K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
1,450 |
1,173 |
$83K |
| A4230 |
Infusion set for external insulin pump, non needle cannula type |
1,099 |
711 |
$80K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
1,007 |
755 |
$79K |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
1,034 |
618 |
$74K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
2,493 |
2,061 |
$72K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
3,746 |
3,035 |
$68K |
| 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 |
1,834 |
1,524 |
$64K |
| A4554 |
Disposable underpads, all sizes |
1,389 |
1,131 |
$58K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
180 |
101 |
$55K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
1,194 |
732 |
$51K |
| A5121 |
Skin barrier; solid, 6 x 6 or equivalent, each |
752 |
614 |
$50K |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
738 |
635 |
$36K |
| A4456 |
Adhesive remover, wipes, any type, each |
5,802 |
4,625 |
$33K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
1,122 |
941 |
$27K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
530 |
457 |
$25K |
| A5056 |
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each |
400 |
327 |
$23K |
| A4452 |
Tape, waterproof, per 18 square inches |
3,116 |
2,573 |
$22K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
681 |
569 |
$22K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
1,908 |
1,572 |
$21K |
| A4371 |
Ostomy skin barrier, powder, per oz |
3,387 |
2,765 |
$20K |
| A5120 |
Skin barrier, wipes or swabs, each |
6,144 |
4,953 |
$18K |
| K0552 |
Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each |
688 |
460 |
$17K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
275 |
218 |
$15K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
1,574 |
1,305 |
$14K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
2,036 |
1,640 |
$14K |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
552 |
437 |
$14K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
171 |
139 |
$14K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
331 |
203 |
$11K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,542 |
2,117 |
$10K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
129 |
110 |
$8K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
72 |
66 |
$6K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,412 |
1,189 |
$6K |
| A4927 |
Gloves, non-sterile, per 100 |
826 |
696 |
$6K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
437 |
337 |
$6K |
| 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 |
136 |
107 |
$6K |
| A4369 |
Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
1,478 |
1,201 |
$5K |
| A4367 |
Ostomy belt, each |
1,262 |
1,039 |
$4K |
| A4388 |
Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each |
78 |
68 |
$4K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,707 |
1,438 |
$3K |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
439 |
350 |
$3K |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
341 |
308 |
$3K |
| A4232 |
Syringe with needle for external insulin pump, sterile, 3 cc |
107 |
94 |
$2K |
| A6199 |
Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches |
61 |
52 |
$2K |
| A4670 |
Automatic blood pressure monitor |
32 |
32 |
$2K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
79 |
70 |
$2K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
228 |
188 |
$2K |
| A4225 |
Supplies for external insulin infusion pump, syringe type cartridge, sterile, each |
219 |
160 |
$1K |
| 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 |
57 |
52 |
$1K |
| A4410 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each |
14 |
12 |
$1K |
| A4427 |
Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each |
51 |
45 |
$985.22 |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
184 |
148 |
$971.98 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
69 |
48 |
$846.34 |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
21 |
12 |
$826.00 |
| A4335 |
Incontinence supply; miscellaneous |
163 |
109 |
$762.47 |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
79 |
68 |
$760.95 |
| A6443 |
Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard |
195 |
173 |
$657.32 |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
13 |
12 |
$608.00 |
| A4224 |
Supplies for maintenance of insulin infusion catheter, per week |
107 |
70 |
$574.96 |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
30 |
29 |
$296.52 |
| A6260 |
Wound cleansers, any type, any size |
12 |
12 |
$154.64 |
| A6207 |
Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
14 |
13 |
$97.87 |
| A4364 |
Adhesive, liquid or equal, any type, per oz |
13 |
12 |
$80.71 |
| A4259 |
Lancets, per box of 100 |
55 |
32 |
$75.26 |
| ZZZZZ |
|
17 |
12 |
$0.00 |