| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0553 |
Ther cgm supply allowance |
628 |
590 |
$108K |
| A4409 |
Ost skn barr convex <=4 sq i |
2,429 |
1,749 |
$39K |
| A4425 |
Ost pch drain for barrier fl |
2,545 |
1,859 |
$33K |
| E0603 |
Electric breast pump |
228 |
228 |
$27K |
| A4407 |
Ext wear ost skn barr <=4sq" |
1,186 |
796 |
$25K |
| A4414 |
Ost sknbar w/o conv<=4 sq in |
2,417 |
1,567 |
$24K |
| A4362 |
Solid skin barrier |
1,943 |
1,427 |
$21K |
| A4385 |
Ost skn barrier sld ext wear |
2,322 |
1,739 |
$21K |
| A6212 |
Foam drg <=16 sq in w/border |
501 |
356 |
$21K |
| T4522 |
Adult size brief/diaper med |
407 |
372 |
$21K |
| A6446 |
Conform band s w>=3" <5"/yd |
1,567 |
1,121 |
$20K |
| A6211 |
Foam drg > 48 sq in w/o brdr |
18 |
12 |
$20K |
| A4351 |
Straight tip urine catheter |
686 |
473 |
$20K |
| A5063 |
Drain ostomy pouch w/flange |
2,103 |
1,415 |
$16K |
| T4534 |
Youth size pull-on |
430 |
360 |
$15K |
| A4554 |
Disposable underpads |
777 |
701 |
$13K |
| A4452 |
Waterproof tape |
1,575 |
1,176 |
$11K |
| A5120 |
Skin barrier, wipe or swab |
5,205 |
3,539 |
$10K |
| A4927 |
Non-sterile gloves |
1,602 |
1,375 |
$9K |
| A4456 |
Adhesive remover, wipes |
2,960 |
2,018 |
$7K |
| A4432 |
Os pch urine w bar/fange/tap |
839 |
535 |
$7K |
| A4357 |
Bedside drainage bag |
3,754 |
2,478 |
$7K |
| A4371 |
Skin barrier powder per oz |
1,746 |
1,336 |
$6K |
| A4353 |
Intermittent urinary cath |
14 |
12 |
$6K |
| A6402 |
Sterile gauze <= 16 sq in |
1,527 |
1,145 |
$6K |
| A4406 |
Pectin based ostomy paste |
1,630 |
1,183 |
$5K |
| A4450 |
Non-waterproof tape |
731 |
570 |
$4K |
| A4394 |
Ostomy pouch liq deodorant |
1,622 |
1,126 |
$3K |
| A4349 |
Disposable male external cat |
184 |
140 |
$2K |
| T4521 |
Adult size brief/diaper sm |
56 |
49 |
$2K |
| A4216 |
Sterile water/saline, 10 ml |
191 |
161 |
$2K |
| A6196 |
Alginate dressing <=16 sq in |
395 |
298 |
$2K |
| A4358 |
Urinary leg or abdomen bag |
761 |
536 |
$1K |
| A6197 |
Alginate drsg >16 <=48 sq in |
31 |
28 |
$1K |
| A4367 |
Ostomy belt |
315 |
222 |
$1K |
| A4424 |
Ost pch drain w bar & filter |
46 |
24 |
$666.75 |
| A4314 |
Cath w/drainage 2-way latex |
1,587 |
1,032 |
$647.32 |
| A4629 |
Tracheostomy care kit |
16 |
12 |
$538.74 |
| A6252 |
Absorpt drg >16 <=48 w/o bdr |
57 |
43 |
$506.08 |
| T4526 |
Adult size pull-on med |
15 |
12 |
$493.00 |
| A6219 |
Gauze <= 16 sq in w/border |
350 |
267 |
$197.24 |
| A4455 |
Adhesive remover per ounce |
74 |
62 |
$180.56 |
| A7526 |
Tracheostomy tube collar |
31 |
24 |
$92.26 |
| A4623 |
Tracheostomy inner cannula |
16 |
12 |
$42.48 |
| A4419 |
Ost pch for bar w flange/flt |
20 |
12 |
$40.15 |
| A4311 |
Catheter w/o bag 2-way latex |
52 |
24 |
$12.43 |
| A4405 |
Nonpectin based ostomy paste |
22 |
12 |
$9.16 |
| A4333 |
Urinary cath anchor device |
31 |
25 |
$2.43 |