| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0603 |
Breast pump, electric (ac and/or dc), any type |
5,852 |
5,320 |
$569K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
775 |
601 |
$42K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
596 |
457 |
$39K |
| A4230 |
Infusion set for external insulin pump, non needle cannula type |
223 |
194 |
$23K |
| B4160 |
Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 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 |
115 |
107 |
$22K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
367 |
282 |
$11K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
285 |
222 |
$11K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
392 |
313 |
$9K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
304 |
242 |
$9K |
| A4225 |
Supplies for external insulin infusion pump, syringe type cartridge, sterile, each |
225 |
193 |
$7K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
351 |
292 |
$5K |
| A4456 |
Adhesive remover, wipes, any type, each |
906 |
695 |
$4K |
| A5120 |
Skin barrier, wipes or swabs, each |
703 |
536 |
$3K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
118 |
101 |
$2K |
| A4371 |
Ostomy skin barrier, powder, per oz |
363 |
301 |
$1K |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
82 |
69 |
$281.85 |
| A4287 |
Disposable collection and storage bag for breast milk, any size, any type, each |
13 |
13 |
$263.55 |
| A4927 |
Gloves, non-sterile, per 100 |
26 |
25 |
$180.75 |
| A4259 |
Lancets, per box of 100 |
13 |
12 |
$51.73 |