| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4230 |
Infus insulin pump non needl |
5,793 |
5,758 |
$1.83M |
| A4239 |
Non-adju cgm supply allow |
3,765 |
3,697 |
$1.03M |
| A4232 |
Syringe w/needle insulin 3cc |
7,357 |
7,325 |
$576K |
| A6021 |
Collagen dressing <=16 sq in |
2,347 |
1,969 |
$391K |
| A4231 |
Infusion insulin pump needle |
1,564 |
1,558 |
$211K |
| A6196 |
Alginate dressing <=16 sq in |
2,370 |
1,988 |
$173K |
| A6197 |
Alginate drsg >16 <=48 sq in |
990 |
796 |
$165K |
| A6266 |
Impreg gauze no h20/sal/yard |
1,115 |
893 |
$156K |
| A4238 |
Adju cgm supply allowance |
587 |
587 |
$153K |
| A6212 |
Foam drg <=16 sq in w/border |
1,019 |
828 |
$134K |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
2,590 |
2,161 |
$124K |
| A6446 |
Conform band s w>=3" <5"/yd |
3,905 |
3,411 |
$66K |
| A4452 |
Waterproof tape |
3,759 |
3,179 |
$62K |
| E2103 |
Non-adju cgm receiver/mon |
153 |
151 |
$32K |
| A4253 |
Blood glucose/reagent strips |
748 |
695 |
$27K |
| A6222 |
Gauze <=16 in no w/sal w/o b |
870 |
658 |
$27K |
| A6253 |
Absorpt drg > 48 sq in w/o b |
358 |
299 |
$26K |
| A6210 |
Foam drg >16<=48 sq in w/o b |
122 |
108 |
$23K |
| A6402 |
Sterile gauze <= 16 sq in |
5,665 |
4,741 |
$20K |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
361 |
282 |
$18K |
| A9276 |
Disposable sensor, cgm sys |
205 |
197 |
$17K |
| A6251 |
Absorpt drg <=16 sq in w/o b |
749 |
629 |
$14K |
| A6452 |
High compres band w>=3"<5"yd |
71 |
50 |
$11K |
| A6199 |
Alginate drsg wound filler |
168 |
133 |
$11K |
| A4450 |
Non-waterproof tape |
2,759 |
2,374 |
$9K |
| A6457 |
Tubular dressing |
307 |
238 |
$8K |
| A4259 |
Lancets per box |
465 |
430 |
$6K |
| A6223 |
Gauze >16<=48 no w/sal w/o b |
187 |
151 |
$5K |
| K0553 |
Ther cgm supply allowance |
29 |
26 |
$4K |
| A4927 |
Non-sterile gloves |
577 |
464 |
$3K |
| A6454 |
Self-adher band w>=3" <5"/yd |
115 |
87 |
$3K |
| A5120 |
Skin barrier, wipe or swab |
353 |
281 |
$2K |
| A6216 |
Non-sterile gauze<=16 sq in |
294 |
262 |
$1K |
| A6260 |
Wound cleanser any type/size |
511 |
452 |
$981.11 |
| A6219 |
Gauze <= 16 sq in w/border |
46 |
40 |
$233.54 |
| A6445 |
Conform band s w <3"/yd |
18 |
12 |
$66.04 |
| A9277 |
External transmitter, cgm |
44 |
39 |
$0.00 |