| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A9276 |
Disposable sensor, cgm sys |
58,216 |
56,437 |
$20.35M |
| A9274 |
Ext amb insulin delivery sys |
16,800 |
15,962 |
$7.83M |
| B4161 |
Ef ped hydrolyzed/amino acid |
5,122 |
4,079 |
$4.76M |
| A9277 |
External transmitter, cgm |
9,149 |
8,819 |
$4.72M |
| E0784 |
Ext amb infusn pump insulin |
1,558 |
1,341 |
$4.70M |
| A4230 |
Infus insulin pump non needl |
26,638 |
25,173 |
$4.56M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
13,535 |
13,237 |
$2.56M |
| A9278 |
External receiver, cgm sys |
3,753 |
3,568 |
$1.90M |
| A4253 |
Blood glucose/reagent strips |
22,335 |
20,883 |
$1.68M |
| A4232 |
Syringe w/needle insulin 3cc |
26,562 |
25,126 |
$1.46M |
| B4035 |
Enteral feed supp pump per d |
6,421 |
6,140 |
$1.39M |
| T4534 |
Youth size pull-on |
9,221 |
9,087 |
$1.05M |
| A9900 |
Supply/accessory/service |
18,756 |
14,349 |
$929K |
| A4554 |
Disposable underpads |
19,449 |
18,973 |
$832K |
| A6257 |
Transparent film <= 16 sq in |
23,545 |
22,756 |
$674K |
| B4150 |
Ef complet w/intact nutrient |
5,117 |
4,840 |
$663K |
| B4149 |
Ef blenderized foods |
1,053 |
1,009 |
$523K |
| E1399 |
Durable medical equipment mi |
6,089 |
1,218 |
$478K |
| B4152 |
Ef calorie dense>/=1.5kcal |
2,352 |
2,180 |
$451K |
| A4245 |
Alcohol wipes per box |
22,451 |
21,719 |
$437K |
| T4530 |
Ped size brief/diaper lg |
4,727 |
4,645 |
$408K |
| A5120 |
Skin barrier, wipe or swab |
25,142 |
24,494 |
$406K |
| B4153 |
Ef hydrolyzed/amino acids |
463 |
424 |
$355K |
| A4927 |
Non-sterile gloves |
20,263 |
19,799 |
$319K |
| T4522 |
Adult size brief/diaper med |
2,989 |
2,924 |
$275K |
| T4532 |
Ped size pull-on lg |
2,481 |
2,446 |
$261K |
| T4526 |
Adult size pull-on med |
2,654 |
2,611 |
$258K |
| B4088 |
Gastro/jejuno tube, low-pro |
3,014 |
2,935 |
$255K |
| T4527 |
Adult size pull-on lg |
2,720 |
2,626 |
$219K |
| B9002 |
Enter nutr inf pump any type |
3,626 |
3,159 |
$209K |
| A4259 |
Lancets per box |
14,212 |
13,214 |
$199K |
| T4525 |
Adult size pull-on sm |
1,741 |
1,716 |
$187K |
| T4528 |
Adult size pull-on xl |
1,585 |
1,550 |
$174K |
| A4250 |
Urine reagent strips/tablets |
8,122 |
7,774 |
$117K |
| B4100 |
Food thickener oral |
1,129 |
913 |
$107K |
| T4523 |
Adult size brief/diaper lg |
1,133 |
1,083 |
$102K |
| T4535 |
Disposable liner/shield/pad |
1,709 |
1,675 |
$89K |
| A4215 |
Sterile needle |
3,907 |
3,654 |
$84K |
| B4102 |
Ef adult fluids and electro |
413 |
296 |
$83K |
| B4154 |
Ef spec metabolic noninherit |
513 |
457 |
$76K |
| A9270 |
Non-covered item or service |
3,084 |
2,700 |
$73K |
| T4521 |
Adult size brief/diaper sm |
634 |
624 |
$53K |
| T4524 |
Adult size brief/diaper xl |
574 |
567 |
$43K |
| A4649 |
Surgical supplies |
300 |
247 |
$42K |
| B4155 |
Ef incomplete/modular |
608 |
578 |
$39K |
| A4409 |
Ost skn barr convex <=4 sq i |
270 |
269 |
$29K |
| A4456 |
Adhesive remover, wipes |
3,359 |
3,260 |
$24K |
| A7003 |
Nebulizer administration set |
2,428 |
2,385 |
$23K |
| A4385 |
Ost skn barrier sld ext wear |
459 |
428 |
$23K |
| A4216 |
Sterile water/saline, 10 ml |
599 |
570 |
$19K |
| A7015 |
Aerosol mask used w nebulize |
2,365 |
2,324 |
$17K |
| S8490 |
100 insulin syringes |
723 |
673 |
$16K |
| B4034 |
Enter feed supkit syr by day |
185 |
165 |
$16K |
| T4543 |
Adult disp brief/diap abv xl |
109 |
108 |
$16K |
| A4425 |
Ost pch drain for barrier fl |
349 |
335 |
$16K |
| K0553 |
Ther cgm supply allowance |
1,314 |
875 |
$16K |
| A4239 |
Non-adju cgm supply allow |
1,034 |
707 |
$16K |
| T4544 |
Adlt disp und/pull on abv xl |
111 |
110 |
$11K |
| A6250 |
Skin seal protect moisturizr |
1,238 |
1,211 |
$10K |
| A4364 |
Adhesive, liquid or equal |
1,773 |
1,710 |
$10K |
| A4406 |
Pectin based ostomy paste |
425 |
417 |
$9K |
| A6212 |
Foam drg <=16 sq in w/border |
72 |
40 |
$8K |
| A4371 |
Skin barrier powder per oz |
506 |
483 |
$7K |
| B9998 |
Enteral supp not otherwise c |
15 |
14 |
$6K |
| A7013 |
Disposable compressor filter |
374 |
365 |
$5K |
| A4357 |
Bedside drainage bag |
198 |
182 |
$4K |
| T4533 |
Youth size brief/diaper |
43 |
39 |
$4K |
| A4450 |
Non-waterproof tape |
357 |
332 |
$3K |
| A4335 |
Incontinence supply |
234 |
229 |
$3K |
| A6402 |
Sterile gauze <= 16 sq in |
469 |
433 |
$3K |
| A4394 |
Ostomy pouch liq deodorant |
181 |
175 |
$3K |
| E0776 |
Iv pole |
313 |
303 |
$2K |
| E0570 |
Nebulizer with compression |
40 |
38 |
$2K |
| A4362 |
Solid skin barrier |
30 |
25 |
$2K |
| A4407 |
Ext wear ost skn barr <=4sq" |
17 |
16 |
$2K |
| T4541 |
Large disposable underpad |
52 |
52 |
$2K |
| T4540 |
Reusable underpad chair size |
225 |
224 |
$2K |
| A4351 |
Straight tip urine catheter |
12 |
12 |
$2K |
| A5063 |
Drain ostomy pouch w/flange |
40 |
38 |
$2K |
| A7002 |
Tubing used w suction pump |
289 |
278 |
$672.21 |
| A6216 |
Non-sterile gauze<=16 sq in |
84 |
81 |
$486.72 |
| A4455 |
Adhesive remover per ounce |
146 |
135 |
$470.42 |
| A4358 |
Urinary leg or abdomen bag |
27 |
25 |
$423.40 |
| A6446 |
Conform band s w>=3" <5"/yd |
34 |
31 |
$388.82 |
| A4256 |
Calibrator solution/chips |
64 |
62 |
$387.94 |
| A4402 |
Lubricant per ounce |
59 |
51 |
$294.25 |
| A4258 |
Lancet device each |
14 |
13 |
$165.67 |
| A4367 |
Ostomy belt |
25 |
24 |
$119.89 |