| 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 |
2,927 |
2,708 |
$1.04M |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
6,004 |
5,425 |
$733K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
3,071 |
2,868 |
$731K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
4,102 |
3,640 |
$424K |
| 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 |
4,499 |
4,180 |
$395K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
3,431 |
3,206 |
$290K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,703 |
2,461 |
$288K |
| 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 |
675 |
628 |
$286K |
| A4452 |
Tape, waterproof, per 18 square inches |
8,442 |
7,789 |
$195K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
785 |
735 |
$186K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
5,213 |
4,729 |
$171K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
3,550 |
3,297 |
$161K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
2,364 |
2,109 |
$148K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
2,392 |
2,145 |
$132K |
| Q0508 |
Miscellaneous supply or accessory for use with an implanted ventricular assist device |
179 |
165 |
$126K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
1,566 |
1,394 |
$122K |
| A5121 |
Skin barrier; solid, 6 x 6 or equivalent, each |
1,701 |
1,483 |
$80K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
9,045 |
8,854 |
$74K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
972 |
861 |
$46K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
230 |
211 |
$45K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
918 |
821 |
$40K |
| A4456 |
Adhesive remover, wipes, any type, each |
3,446 |
3,094 |
$34K |
| A6207 |
Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
176 |
168 |
$33K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
1,799 |
1,608 |
$30K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
4,848 |
4,161 |
$30K |
| A6010 |
Collagen based wound filler, dry form, sterile, per gram of collagen |
77 |
65 |
$28K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
2,223 |
1,959 |
$28K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
985 |
857 |
$27K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
2,419 |
2,181 |
$26K |
| A6251 |
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
595 |
559 |
$24K |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
4,102 |
3,518 |
$22K |
| A5120 |
Skin barrier, wipes or swabs, each |
3,785 |
3,373 |
$21K |
| A4623 |
Tracheostomy, inner cannula |
490 |
442 |
$19K |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
4,878 |
4,170 |
$18K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,523 |
2,354 |
$17K |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
651 |
612 |
$16K |
| 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 |
222 |
215 |
$14K |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
568 |
552 |
$14K |
| 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 |
463 |
378 |
$13K |
| A6213 |
Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
129 |
119 |
$11K |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
311 |
274 |
$7K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
816 |
685 |
$7K |
| A6022 |
Collagen dressing, sterile, size more than 16 sq. in. but less than or equal to 48 sq. in., each |
12 |
12 |
$7K |
| A6261 |
Wound filler, gel/paste, per fluid ounce, not otherwise specified |
295 |
274 |
$6K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
1,077 |
913 |
$6K |
| A6449 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard |
102 |
99 |
$6K |
| A6240 |
Hydrocolloid dressing, wound filler, paste, sterile, per ounce |
69 |
62 |
$5K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
1,630 |
1,509 |
$5K |
| A4371 |
Ostomy skin barrier, powder, per oz |
1,852 |
1,635 |
$3K |
| A5131 |
Appliance cleaner, incontinence and ostomy appliances, per 16 oz. |
578 |
475 |
$3K |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
27 |
26 |
$1K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
13 |
12 |
$767.68 |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
79 |
74 |
$473.10 |
| A6441 |
Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard |
27 |
24 |
$411.85 |
| A6220 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
28 |
26 |
$409.80 |
| A6260 |
Wound cleansers, any type, any size |
1,064 |
1,043 |
$363.47 |
| A6206 |
Contact layer, sterile, 16 sq. in. or less, each dressing |
12 |
12 |
$357.27 |
| A4247 |
Betadine or iodine swabs/wipes, per box |
13 |
13 |
$345.08 |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
20 |
15 |
$287.56 |
| A6242 |
Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
12 |
12 |
$276.78 |
| A4344 |
Indwelling catheter, foley type, two-way, all silicone or polyurethane, each |
38 |
37 |
$244.96 |
| A4217 |
Sterile water/saline, 500 ml |
73 |
69 |
$162.07 |