| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0603 |
Breast pump, electric (ac and/or dc), any type |
652 |
648 |
$77K |
| 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 |
799 |
754 |
$35K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
252 |
223 |
$22K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
1,241 |
1,145 |
$17K |
| A4452 |
Tape, waterproof, per 18 square inches |
682 |
634 |
$12K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
280 |
273 |
$11K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
334 |
317 |
$10K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,659 |
1,525 |
$9K |
| 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 |
44 |
40 |
$7K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
69 |
65 |
$6K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
133 |
131 |
$4K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
950 |
891 |
$4K |
| A6216 |
Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
410 |
381 |
$2K |
| A5120 |
Skin barrier, wipes or swabs, each |
752 |
712 |
$2K |
| A4456 |
Adhesive remover, wipes, any type, each |
420 |
402 |
$2K |
| A4927 |
Gloves, non-sterile, per 100 |
247 |
234 |
$2K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
90 |
88 |
$1K |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
19 |
19 |
$848.16 |
| A6260 |
Wound cleansers, any type, any size |
238 |
213 |
$839.59 |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
26 |
26 |
$609.92 |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
14 |
14 |
$535.84 |
| A4371 |
Ostomy skin barrier, powder, per oz |
48 |
47 |
$96.77 |