| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
628 |
590 |
$108K |
| A4409 |
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
2,429 |
1,749 |
$39K |
| A4425 |
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
2,545 |
1,859 |
$33K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
228 |
228 |
$27K |
| A4407 |
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
1,186 |
796 |
$25K |
| A4414 |
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
2,417 |
1,567 |
$24K |
| A4362 |
Skin barrier; solid, 4 x 4 or equivalent; each |
1,943 |
1,427 |
$21K |
| A4385 |
Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
2,322 |
1,739 |
$21K |
| A6212 |
Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
501 |
356 |
$21K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
407 |
372 |
$21K |
| A6446 |
Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard |
1,567 |
1,121 |
$20K |
| A6211 |
Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
18 |
12 |
$20K |
| A4351 |
Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each |
686 |
473 |
$20K |
| A5063 |
Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each |
2,103 |
1,415 |
$16K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
430 |
360 |
$15K |
| A4554 |
Disposable underpads, all sizes |
777 |
701 |
$13K |
| A4452 |
Tape, waterproof, per 18 square inches |
1,575 |
1,176 |
$11K |
| A5120 |
Skin barrier, wipes or swabs, each |
5,205 |
3,539 |
$10K |
| A4927 |
Gloves, non-sterile, per 100 |
1,602 |
1,375 |
$9K |
| A4456 |
Adhesive remover, wipes, any type, each |
2,960 |
2,018 |
$7K |
| A4432 |
Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
839 |
535 |
$7K |
| A4357 |
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
3,754 |
2,478 |
$7K |
| A4371 |
Ostomy skin barrier, powder, per oz |
1,746 |
1,336 |
$6K |
| A4353 |
Intermittent urinary catheter, with insertion supplies |
14 |
12 |
$6K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
1,527 |
1,145 |
$6K |
| A4406 |
Ostomy skin barrier, pectin-based, paste, per ounce |
1,630 |
1,183 |
$5K |
| A4450 |
Tape, non-waterproof, per 18 square inches |
731 |
570 |
$4K |
| A4394 |
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
1,622 |
1,126 |
$3K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
184 |
140 |
$2K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
56 |
49 |
$2K |
| A4216 |
Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
191 |
161 |
$2K |
| A6196 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing |
395 |
298 |
$2K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
761 |
536 |
$1K |
| 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 |
31 |
28 |
$1K |
| A4367 |
Ostomy belt, each |
315 |
222 |
$1K |
| A4424 |
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
46 |
24 |
$666.75 |
| A4314 |
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
1,587 |
1,032 |
$647.32 |
| A4629 |
Tracheostomy care kit for established tracheostomy |
16 |
12 |
$538.74 |
| 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 |
57 |
43 |
$506.08 |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
15 |
12 |
$493.00 |
| A6219 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing |
350 |
267 |
$197.24 |
| A4455 |
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
74 |
62 |
$180.56 |
| A7526 |
Tracheostomy tube collar/holder, each |
31 |
24 |
$92.26 |
| A4623 |
Tracheostomy, inner cannula |
16 |
12 |
$42.48 |
| A4419 |
Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
20 |
12 |
$40.15 |
| A4311 |
Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
52 |
24 |
$12.43 |
| A4405 |
Ostomy skin barrier, non-pectin based, paste, per ounce |
22 |
12 |
$9.16 |
| A4333 |
Urinary catheter anchoring device, adhesive skin attachment, each |
31 |
25 |
$2.43 |