| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A9276 |
Disposable sensor, cgm sys |
296,047 |
280,762 |
$110.80M |
| E0784 |
Ext amb infusn pump insulin |
97,863 |
88,105 |
$39.56M |
| A4230 |
Infus insulin pump non needl |
187,117 |
180,783 |
$23.29M |
| A9277 |
External transmitter, cgm |
36,121 |
33,864 |
$22.71M |
| A4239 |
Non-adju cgm supply allow |
221,294 |
188,972 |
$17.39M |
| K0553 |
Ther cgm supply allowance |
188,973 |
167,060 |
$10.26M |
| A4232 |
Syringe w/needle insulin 3cc |
208,146 |
201,313 |
$6.84M |
| A9274 |
Ext amb insulin delivery sys |
16,838 |
15,867 |
$6.22M |
| A9278 |
External receiver, cgm sys |
10,116 |
9,502 |
$5.07M |
| A4353 |
Intermittent urinary cath |
7,138 |
6,249 |
$3.59M |
| A4224 |
Supply insulin inf cath/wk |
77,589 |
66,943 |
$2.28M |
| A4231 |
Infusion insulin pump needle |
22,677 |
22,039 |
$2.13M |
| A4238 |
Adju cgm supply allowance |
13,572 |
11,770 |
$1.29M |
| E1399 |
Durable medical equipment mi |
2,180 |
2,035 |
$1.29M |
| A4351 |
Straight tip urine catheter |
10,548 |
8,990 |
$1.18M |
| A4225 |
Sup/ext insulin inf pump syr |
77,430 |
67,482 |
$950K |
| E2103 |
Non-adju cgm receiver/mon |
11,939 |
9,816 |
$640K |
| K0554 |
Ther cgm receiver/monitor |
12,268 |
10,363 |
$576K |
| A6021 |
Collagen dressing <=16 sq in |
1,744 |
1,279 |
$530K |
| A4253 |
Blood glucose/reagent strips |
13,477 |
11,997 |
$415K |
| E0603 |
Electric breast pump |
4,277 |
4,197 |
$408K |
| A4409 |
Ost skn barr convex <=4 sq i |
6,623 |
5,640 |
$406K |
| A4385 |
Ost skn barrier sld ext wear |
8,257 |
7,253 |
$405K |
| A4352 |
Coude tip urinary catheter |
1,312 |
1,069 |
$375K |
| A4407 |
Ext wear ost skn barr <=4sq" |
4,293 |
3,723 |
$318K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
3,944 |
3,599 |
$241K |
| A6266 |
Impreg gauze no h20/sal/yard |
1,367 |
1,117 |
$214K |
| A6196 |
Alginate dressing <=16 sq in |
1,269 |
1,018 |
$204K |
| A4362 |
Solid skin barrier |
5,091 |
4,491 |
$196K |
| A6257 |
Transparent film <= 16 sq in |
2,638 |
2,386 |
$190K |
| A6197 |
Alginate drsg >16 <=48 sq in |
504 |
357 |
$190K |
| A4425 |
Ost pch drain for barrier fl |
5,086 |
4,397 |
$171K |
| A5063 |
Drain ostomy pouch w/flange |
5,679 |
5,128 |
$164K |
| A4349 |
Disposable male external cat |
3,799 |
3,298 |
$149K |
| A6212 |
Foam drg <=16 sq in w/border |
992 |
600 |
$148K |
| A6446 |
Conform band s w>=3" <5"/yd |
2,843 |
2,167 |
$117K |
| A4388 |
Drainable pch w ex wear barr |
1,924 |
1,698 |
$104K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
1,317 |
1,051 |
$101K |
| A4357 |
Bedside drainage bag |
8,992 |
7,808 |
$92K |
| A4452 |
Waterproof tape |
4,585 |
3,842 |
$83K |
| A5120 |
Skin barrier, wipe or swab |
11,621 |
10,430 |
$79K |
| A4394 |
Ostomy pouch liq deodorant |
6,520 |
5,665 |
$77K |
| A4432 |
Os pch urine w bar/fange/tap |
2,454 |
1,993 |
$71K |
| A4456 |
Adhesive remover, wipes |
8,137 |
7,385 |
$69K |
| A5057 |
1 pc ost pou w built-in conv |
516 |
443 |
$65K |
| A4221 |
Supp non-insulin inf cath/wk |
802 |
766 |
$62K |
| A4259 |
Lancets per box |
7,801 |
7,005 |
$60K |
| A5061 |
Pouch drainable w barrier at |
1,333 |
1,188 |
$57K |
| A4406 |
Pectin based ostomy paste |
5,219 |
4,843 |
$54K |
| E0781 |
External ambulatory infus pu |
12 |
12 |
$49K |
| A4419 |
Ost pch for bar w flange/flt |
1,454 |
1,216 |
$45K |
| A4358 |
Urinary leg or abdomen bag |
5,680 |
4,970 |
$38K |
| K0552 |
Sup/ext non-ins inf pump syr |
1,319 |
1,286 |
$36K |
| A4371 |
Skin barrier powder per oz |
6,305 |
5,709 |
$35K |
| A4424 |
Ost pch drain w bar & filter |
670 |
602 |
$35K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
621 |
483 |
$31K |
| A6402 |
Sterile gauze <= 16 sq in |
4,110 |
3,428 |
$28K |
| A4314 |
Cath w/drainage 2-way latex |
1,722 |
1,469 |
$24K |
| A4332 |
Lube sterile packet |
2,645 |
2,211 |
$24K |
| K0603 |
Repl batt alkaline 1.5 v |
7,534 |
6,681 |
$24K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
134 |
105 |
$23K |
| T4541 |
Large disposable underpad |
751 |
251 |
$19K |
| A4927 |
Non-sterile gloves |
2,453 |
1,984 |
$19K |
| A6258 |
Transparent film >16<=48 in |
189 |
179 |
$18K |
| A4427 |
Ost pch drain/barr lk flng/f |
462 |
421 |
$16K |
| T4526 |
Adult size pull-on med |
245 |
67 |
$15K |
| T4525 |
Adult size pull-on sm |
246 |
75 |
$15K |
| A4367 |
Ostomy belt |
2,627 |
2,403 |
$14K |
| A4389 |
Drainable pch w st wear barr |
152 |
135 |
$12K |
| A6452 |
High compres band w>=3"<5"yd |
59 |
49 |
$12K |
| A4326 |
Male external catheter |
145 |
138 |
$11K |
| A4450 |
Non-waterproof tape |
3,389 |
2,889 |
$11K |
| A4402 |
Lubricant per ounce |
2,406 |
2,143 |
$11K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
51 |
42 |
$9K |
| A6260 |
Wound cleanser any type/size |
1,250 |
1,020 |
$8K |
| A4369 |
Skin barrier liquid per oz |
1,597 |
1,401 |
$7K |
| A4455 |
Adhesive remover per ounce |
918 |
849 |
$5K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
87 |
73 |
$5K |
| A4258 |
Lancet device each |
817 |
704 |
$5K |
| T4534 |
Youth size pull-on |
80 |
13 |
$5K |
| A6251 |
Absorpt drg <=16 sq in w/o b |
152 |
124 |
$5K |
| A4390 |
Drainable pch ex wear convex |
82 |
78 |
$5K |
| A6457 |
Tubular dressing |
271 |
188 |
$5K |
| A5054 |
Clsd ostomy pouch w/flange |
225 |
193 |
$5K |
| A4364 |
Adhesive, liquid or equal |
705 |
671 |
$5K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
14 |
12 |
$4K |
| A6216 |
Non-sterile gauze<=16 sq in |
829 |
698 |
$4K |
| A6250 |
Skin seal protect moisturizr |
230 |
209 |
$4K |
| A4245 |
Alcohol wipes per box |
1,630 |
1,589 |
$4K |
| A4410 |
Ost skn barr extnd >4 sq |
45 |
37 |
$4K |
| T4535 |
Disposable liner/shield/pad |
152 |
38 |
$3K |
| A4256 |
Calibrator solution/chips |
974 |
828 |
$3K |
| A6454 |
Self-adher band w>=3" <5"/yd |
44 |
39 |
$3K |
| A4430 |
Ost urine pch w b/bltin conv |
25 |
24 |
$2K |
| T4527 |
Adult size pull-on lg |
24 |
13 |
$2K |
| E0607 |
Blood glucose monitor home |
47 |
42 |
$1K |
| E2102 |
Adju cgm receiver/monitor |
311 |
273 |
$771.08 |
| A4602 |
Replace lithium battery 1.5v |
240 |
227 |
$763.27 |
| E0787 |
Cgs dose adj insulin inf pmp |
29 |
27 |
$561.50 |
| A4373 |
Skin barrier with flange |
14 |
13 |
$530.87 |
| A6219 |
Gauze <= 16 sq in w/border |
14 |
13 |
$378.47 |
| A4356 |
Ext ureth clmp or compr dvc |
47 |
46 |
$289.15 |
| A5112 |
Urinary leg bag |
13 |
12 |
$156.27 |
| A4405 |
Nonpectin based ostomy paste |
13 |
12 |
$86.38 |
| A4226 |
Weekly supply maint cgs pump |
22 |
17 |
$0.00 |