| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4400 |
Ostomy irrigation set |
779 |
563 |
$400K |
| A6247 |
Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing |
571 |
535 |
$300K |
| A4417 |
Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (1 piece), each |
333 |
214 |
$266K |
| A6244 |
Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
611 |
574 |
$242K |
| A5057 |
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each |
626 |
590 |
$179K |
| A5122 |
Skin barrier; solid, 8 x 8 or equivalent, each |
740 |
698 |
$169K |
| A6236 |
Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
352 |
334 |
$139K |
| A4413 |
Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), with filter, each |
337 |
216 |
$119K |
| A4554 |
Disposable underpads, all sizes |
1,277 |
1,227 |
$72K |
| 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 |
113 |
106 |
$63K |
| A6235 |
Hydrocolloid 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 |
139 |
131 |
$45K |
| A4384 |
Ostomy faceplate equivalent, silicone ring, each |
286 |
275 |
$28K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
425 |
419 |
$15K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
237 |
233 |
$12K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
121 |
117 |
$11K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
165 |
157 |
$6K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
81 |
73 |
$5K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
43 |
42 |
$4K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
52 |
47 |
$4K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
25 |
24 |
$4K |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
60 |
56 |
$3K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
65 |
65 |
$3K |
| A4927 |
Gloves, non-sterile, per 100 |
528 |
506 |
$2K |
| A4452 |
Tape, waterproof, per 18 square inches |
48 |
45 |
$2K |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
98 |
98 |
$664.44 |
| A4367 |
Ostomy belt, each |
95 |
87 |
$623.94 |
| A4371 |
Ostomy skin barrier, powder, per oz |
79 |
71 |
$519.98 |
| A5120 |
Skin barrier, wipes or swabs, each |
39 |
36 |
$352.00 |
| K0004 |
High strength, lightweight wheelchair |
12 |
12 |
$318.48 |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
12 |
12 |
$258.84 |