| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6010 |
Collagen based wound filler, dry form, sterile, per gram of collagen |
8,298 |
6,898 |
$1000K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
7,329 |
6,076 |
$724K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
18,729 |
14,972 |
$603K |
| 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 |
3,648 |
3,072 |
$572K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
7,785 |
6,447 |
$249K |
| A6266 |
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard |
2,207 |
2,015 |
$217K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
3,130 |
2,003 |
$164K |
| B4152 |
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 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 |
5,601 |
3,770 |
$158K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
4,358 |
3,525 |
$117K |
| 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 |
2,895 |
2,478 |
$94K |
| A6253 |
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
455 |
392 |
$61K |
| A6251 |
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
7,072 |
5,742 |
$53K |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
21,417 |
17,397 |
$51K |
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
2,345 |
1,519 |
$45K |
| A4452 |
Tape, waterproof, per 18 square inches |
11,711 |
9,664 |
$43K |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
16,722 |
13,118 |
$42K |
| A6209 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
2,249 |
1,896 |
$41K |
| B4034 |
Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
2,062 |
1,744 |
$40K |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
12,795 |
10,832 |
$37K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
4,300 |
3,556 |
$32K |
| B9002 |
Enteral nutrition infusion pump, any type |
604 |
508 |
$30K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
2,116 |
1,718 |
$28K |
| B4153 |
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
582 |
281 |
$25K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
1,834 |
1,489 |
$23K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
8,791 |
7,214 |
$21K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
22,040 |
17,944 |
$21K |
| A6242 |
Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
338 |
314 |
$16K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
1,825 |
1,482 |
$16K |
| A6223 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing |
547 |
477 |
$16K |
| A6248 |
Hydrogel dressing, wound filler, gel, per fluid ounce |
1,829 |
1,579 |
$15K |
| A4623 |
Tracheostomy, inner cannula |
2,316 |
1,991 |
$13K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
1,349 |
1,176 |
$10K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
7,931 |
6,700 |
$10K |
| A6022 |
Collagen dressing, sterile, size more than 16 sq. in. but less than or equal to 48 sq. in., each |
88 |
83 |
$9K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
795 |
650 |
$8K |
| A4629 |
Tracheostomy care kit for established tracheostomy |
2,139 |
1,817 |
$7K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
2,716 |
2,344 |
$6K |
| B4087 |
Gastrostomy/jejunostomy tube, standard, any material, any type, each |
1,138 |
1,085 |
$6K |
| A6457 |
Tubular dressing with or without elastic, any width, per linear yard |
273 |
236 |
$6K |
| A4315 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone |
2,075 |
1,814 |
$6K |
| A6403 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing |
466 |
430 |
$5K |
| A7526 |
Tracheostomy tube collar/holder, each |
2,205 |
1,863 |
$4K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
491 |
448 |
$4K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
2,158 |
1,875 |
$4K |
| A6450 |
Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard |
1,056 |
914 |
$4K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
4,525 |
3,604 |
$4K |
| A5120 |
Skin barrier, wipes or swabs, each |
5,259 |
4,482 |
$4K |
| A6234 |
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
271 |
242 |
$3K |
| A4334 |
Urinary catheter anchoring device, leg strap, each |
6,759 |
5,533 |
$3K |
| A4340 |
Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each |
411 |
303 |
$2K |
| A4456 |
Adhesive remover, wipes, any type, each |
3,191 |
2,730 |
$2K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
93 |
78 |
$2K |
| A6220 |
Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing |
468 |
400 |
$2K |
| A6240 |
Hydrocolloid dressing, wound filler, paste, sterile, per ounce |
245 |
208 |
$2K |
| A6199 |
Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches |
46 |
37 |
$1K |
| A4388 |
Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each |
279 |
248 |
$1K |
| A4354 |
Insertion tray with drainage bag but without catheter |
337 |
252 |
$892.33 |
| A4371 |
Ostomy skin barrier, powder, per oz |
1,995 |
1,720 |
$866.54 |
| A6210 |
Foam 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 |
19 |
15 |
$705.85 |
| A6454 |
Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard |
232 |
201 |
$620.63 |
| A7521 |
Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each |
455 |
447 |
$464.14 |
| A5061 |
Ostomy pouch, drainable; with barrier attached, (1 piece), each |
56 |
53 |
$377.50 |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
67 |
66 |
$296.21 |
| A4311 |
Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
346 |
311 |
$166.03 |
| A6445 |
Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard |
12 |
12 |
$153.04 |
| A4338 |
Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
43 |
27 |
$74.22 |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
31 |
27 |
$51.12 |
| A4310 |
Insertion tray without drainage bag and without catheter (accessories only) |
45 |
28 |
$44.28 |
| A4450 |
Tape, non-waterproof, per 18 square inches |
20 |
20 |
$31.28 |
| A6261 |
Wound filler, gel/paste, per fluid ounce, not otherwise specified |
212 |
171 |
$27.91 |