| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6197 |
Alginate drsg >16 <=48 sq in |
1,915 |
1,522 |
$316K |
| A4385 |
Ost skn barrier sld ext wear |
5,837 |
4,690 |
$298K |
| A4409 |
Ost skn barr convex <=4 sq i |
4,076 |
3,320 |
$261K |
| A4407 |
Ext wear ost skn barr <=4sq" |
2,300 |
1,823 |
$169K |
| A4425 |
Ost pch drain for barrier fl |
3,353 |
2,783 |
$122K |
| A6021 |
Collagen dressing <=16 sq in |
1,101 |
897 |
$119K |
| A4362 |
Solid skin barrier |
3,468 |
2,781 |
$111K |
| A6196 |
Alginate dressing <=16 sq in |
1,856 |
1,409 |
$86K |
| A6212 |
Foam drg <=16 sq in w/border |
1,450 |
1,173 |
$83K |
| A4230 |
Infus insulin pump non needl |
1,099 |
711 |
$80K |
| A4351 |
Straight tip urine catheter |
1,007 |
755 |
$79K |
| A5057 |
1 pc ost pou w built-in conv |
1,034 |
618 |
$74K |
| A5063 |
Drain ostomy pouch w/flange |
2,493 |
2,061 |
$72K |
| A4394 |
Ostomy pouch liq deodorant |
3,746 |
3,035 |
$68K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
1,834 |
1,524 |
$64K |
| A4554 |
Disposable underpads |
1,389 |
1,131 |
$58K |
| A4353 |
Intermittent urinary cath |
180 |
101 |
$55K |
| A4239 |
Non-adju cgm supply allow |
1,194 |
732 |
$51K |
| A5121 |
Solid skin barrier 6x6 |
752 |
614 |
$50K |
| A4419 |
Ost pch for bar w flange/flt |
738 |
635 |
$36K |
| A4456 |
Adhesive remover, wipes |
5,802 |
4,625 |
$33K |
| K0553 |
Ther cgm supply allowance |
1,122 |
941 |
$27K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
530 |
457 |
$25K |
| A5056 |
1 pc ost pouch w filter |
400 |
327 |
$23K |
| A4452 |
Waterproof tape |
3,116 |
2,573 |
$22K |
| A4432 |
Os pch urine w bar/fange/tap |
681 |
569 |
$22K |
| A4406 |
Pectin based ostomy paste |
1,908 |
1,572 |
$21K |
| A4371 |
Skin barrier powder per oz |
3,387 |
2,765 |
$20K |
| A5120 |
Skin barrier, wipe or swab |
6,144 |
4,953 |
$18K |
| K0552 |
Sup/ext non-ins inf pump syr |
688 |
460 |
$17K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
275 |
218 |
$15K |
| A4357 |
Bedside drainage bag |
1,574 |
1,305 |
$14K |
| A6446 |
Conform band s w>=3" <5"/yd |
2,036 |
1,640 |
$14K |
| A6449 |
Lt compres band >=3" <5"/yd |
552 |
437 |
$14K |
| T4528 |
Adult size pull-on xl |
171 |
139 |
$14K |
| E0603 |
Electric breast pump |
331 |
203 |
$11K |
| A6402 |
Sterile gauze <= 16 sq in |
2,542 |
2,117 |
$10K |
| T4526 |
Adult size pull-on med |
129 |
110 |
$8K |
| T4527 |
Adult size pull-on lg |
72 |
66 |
$6K |
| A6216 |
Non-sterile gauze<=16 sq in |
1,412 |
1,189 |
$6K |
| A4927 |
Non-sterile gloves |
826 |
696 |
$6K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
437 |
337 |
$6K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
136 |
107 |
$6K |
| A4369 |
Skin barrier liquid per oz |
1,478 |
1,201 |
$5K |
| A4367 |
Ostomy belt |
1,262 |
1,039 |
$4K |
| A4388 |
Drainable pch w ex wear barr |
78 |
68 |
$4K |
| A4450 |
Non-waterproof tape |
1,707 |
1,438 |
$3K |
| A4455 |
Adhesive remover per ounce |
439 |
350 |
$3K |
| A6457 |
Tubular dressing |
341 |
308 |
$3K |
| A4232 |
Syringe w/needle insulin 3cc |
107 |
94 |
$2K |
| A6199 |
Alginate drsg wound filler |
61 |
52 |
$2K |
| A4670 |
Automatic bp monitor, dial |
32 |
32 |
$2K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
79 |
70 |
$2K |
| A4358 |
Urinary leg or abdomen bag |
228 |
188 |
$2K |
| A4225 |
Sup/ext insulin inf pump syr |
219 |
160 |
$1K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
57 |
52 |
$1K |
| A4410 |
Ost skn barr extnd >4 sq |
14 |
12 |
$1K |
| A4427 |
Ost pch drain/barr lk flng/f |
51 |
45 |
$985.22 |
| A4310 |
Insert tray w/o bag/cath |
184 |
148 |
$971.98 |
| A4253 |
Blood glucose/reagent strips |
69 |
48 |
$846.34 |
| T4534 |
Youth size pull-on |
21 |
12 |
$826.00 |
| A4335 |
Incontinence supply |
163 |
109 |
$762.47 |
| A4338 |
Indwelling catheter latex |
79 |
68 |
$760.95 |
| A6443 |
Conform band n/s w>=3"<5"/yd |
195 |
173 |
$657.32 |
| A5061 |
Pouch drainable w barrier at |
13 |
12 |
$608.00 |
| A4224 |
Supply insulin inf cath/wk |
107 |
70 |
$574.96 |
| A6454 |
Self-adher band w>=3" <5"/yd |
30 |
29 |
$296.52 |
| A6260 |
Wound cleanser any type/size |
12 |
12 |
$154.64 |
| A6207 |
Contact layer >16<= 48 sq in |
14 |
13 |
$97.87 |
| A4364 |
Adhesive, liquid or equal |
13 |
12 |
$80.71 |
| A4259 |
Lancets per box |
55 |
32 |
$75.26 |
| ZZZZZ |
|
17 |
12 |
$0.00 |